Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Comparison Between T2, Stir And Psir Sequences, For Detection Of Cervical Cord Ms Plaques95957552310.22034/icrj.2018.75523ENAmin Abolhasani ForoughiShiraz University of Medical SciencesBanafsheh Zeinali-RafsanjaniMedical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IranMahdi Saeedi-MoghadamMedical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IranMasoume NazeriShiraz University of medical SciencesJournal Article20181026Background:<br /> Multiple Sclerosis is a demyelinating disease which involve almost 2.5 million people all around the world. There are different MR pulse sequences which are used to detect MS plaques. This study is intended to compare, T2 weighted, STIR and PSIR pulse sequences, for the detection of cervical spinal cord lesions of patients with MS.<br /> Materials and Methods:<br /> 60 patients who definitely diagnosed as MS, participated in this study during 6 months from June to December 2016. 1.5 T Siemens (Avanto, Erlangen, Germany) MR scanner and three pulse sequences (T2 weighted, STIR and PSIR sequences) were used for cervical cord MR imaging in the patients. In order to assess the effectiveness of these pulse sequences, the lesion to cord ratio (LCR) and lesion to noise ratio (LNR) were calculated.<br /> Results:<br /> The LCR and LNR of the T2 and PSIR were the same, just the intensities were reverse. STIR had a significantly different LCR and LNR so it was better for the diagnosis of cervical cord MS plaques.<br /> Discussion and Conclusion:<br /> According to that results by using 1.5 Tesla MRI machine, it can imply that the STIR pulse sequence was the best pulse sequence in comparison to T2 and PSIR for detection of cervical cord MS plaques.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Comparison Between Proton Density And T2 Weighted Sequences For Detection Of Cervical Cord Lesions In Multiple Sclerosis96967552710.22034/icrj.2018.75527ENAmin Abolhasani ForoughiShiraz University of Medical SciencesFaranak RafieiShiraz University of Medical SciencesMasoume NazeriShiraz University of medical SciencesJournal Article20181026Introduction:<br /> Magnetic resonance imaging (MRI) is the gold standard imaging technique for identification of demyelinating lesions such as Multiple Sclerosis (MS). The Consortium of MS Centers Consensus (CMSC) Guidelines has recommended 2D proton density/T2 weighted sequences in standard MS spinal cord imaging protocol. The present study is conducted to compare two major CMSC standard spinal cord sequences, proton density (PD) and T2 weighted images, in the detection of cervical spinal cord lesions of patients with MS.<br /> Material and Methods:<br /> 130 patients with clinically definite MS were imaged during a period from February 2014 to June 2015. 100 of these patients, who had cervical spinal cord lesions were included in this study. An institutional protocol for MS lesion detection consistent with the CMSC clinical guidelines which include sagittal T2-fast spin echo, sagittal T1-fast spin echo, sagittal PD-fast spin echo and axial T2WI through cervical cord from C1/2 to T1 vertebrae, were performed for all included patients. The data were analyzed in order to assess lesion-to-cord contrast ratio (LCR) and lesion-contrast-to-noise ratio (LNR).<br /> Results:<br /> LCR was significantly higher in T2 weighted images (35.3), in comparison to PD images (24.2). No statistically significant difference was detected between LNR of T2 and PD weighted images (P= 0.2). PDWI could not detect the black hole plaques of MS due to more water content of such lesions.<br /> Conclusin:<br /> Sagittal T2 weighted imaging appears to be superior in comparison to PD sequence for detection of cervical cord MS lesions. Our study questions CMSC guideline in using the PD as a core spinal cord imaging sequence.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Tc-99m Maa Liver Mapping Prior To Sirt: Factors That Affect Pulmonary Shunt Fraction97977552810.22034/icrj.2018.75528ENFatemeh BehniaUniversity of WashingtonJournal Article20181026Purpose:<br /> To evaluate differences in fraction of particles shunting to the lungs and possible factors contributing to these differences across patients undergoing Tc-99m MAA mapping prior to Selective Internal Radiation Therapy (SIRT) with Y-90 microspheres.<br /> Patients and Methods:<br /> Retrospective analysis of data for 130 patients with hepatocellular carcinoma (HCC) or liver metastases, who underwent arterial 90Y radioembolization over a 6-year period at University of Washington Medical Center. All patients who received treatment had undergone prior arterial Tc-99m MAA mapping to predict distribution of radioembolization particles. Overall 141 Tc-99m MAA injections and 199 90Y treatments were performed in these 130 patients. Three patients were denied Y-90 treatment following Tc-99m MAA mapping due to abnormally high pulmonary shunt fraction. Pulmonary shunt fractions were compared between patients with HCC and those with metastatic disease to the liver. Further comparison of shunt fraction was made between patients who had had mapping of the entire liver, versus of a single lobe. The relationship between the pulmonary shunt fraction and the volume of liver injected for mapping was also evaluated.<br /> Results:<br /> Based on the retrospective analysis of data from 141 Tc-99m MAA liver mapping in 130 patients, unilobar mapping had been performed more commonly in the HCC group. Unilobar mapping prior to bi-lobar SIRT had also become more common over time during the 6-year period reviewed. This could be attributed to interventional radiologists gaining more confidence over time in the predictive value of unilobar mapping prior to bi-lobar treatment. Although qualitatively, the HCC and the non-HCC groups had similar distribution of shunt fractions, relatively large shunt fractions were slightly more common in the HCC group. In diffuse injections, most of the shunt fractions were concentrated between 0 and 5%, but with a long tail to the right. In unilobar injections, most were concentrated between 0 and 10%. There was a strong indication of a difference in pulmonary shunt fraction between the diffuse and unilobar groups, the latter being higher, but only in the subset of patients with HCC.<br /> Conclusions:<br /> The average shunt fraction is overall higher in HCC patients than in patients with hepatic metastases, likely due to underlying cirrhosis as well as intra-tumoral arteriovenous shunting. Contrary to expectations, shunt fractions tend to be higher when only one lobe is injected versus when the entire liver is being mapped.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Multiparametric Magnetic Resonance Imaging Of The Prostate For Tumor Detection And Local Staging98987552910.22034/icrj.2018.75529ENAbolfazl MoslemiShahid Beheshti Medical UniversityJournal Article20181026Background:<br /> Our aim was to detect the performance characteristics of multiparametric magnetic resonance imaging (mp-MRI) in patients with clinical suspicion, or previous diagnosis, of prostate cancer. The study sought to prospectively evaluate which technique among T2-weighted images, dynamic contrast-enhanced (DCE), magnetic resonance spectroscopy (MRS), diffusion-weighted (DW) MRI, or a combination of the 2, is best suited for prostate cancer detection and local staging.<br /> Patients & Methods:<br /> Thirty-seven consecutive patients with biopsy result of the prostate underwent MRI on a 1.5T scanner with combination of surface phased-array coil and endorectal coil (ERC) prior biopsy. Combined anatomical and functional imaging was performed with the use of T2-weighted sequences, DCE MRI, MRS and DW MRI. We compared the imaging results based on PI-RADS schem with Gleason score.<br /> Results:<br /> For the multiparametric approach, significantly higher sensitivity values, that is, 63% (95% confidence interval [CI]) were obtained as compared with each modality alone or any combination of the 3 modalities (P < .05). The specificity for this multiparametric approach, being 90.3% (95% CI) was not significantly higher (P < .05) as compared with the values of the combination of T2DCE MRI, T2 DW MRI, or T2MRS. Among the 3 techniques, T2DW MRI had the best performance for tumour detection in both the peripheral and the transition zone. High negative predictive value rates (>86%) were obtained for both tumor detection and local staging.<br /> Conclusions:<br /> The combination of T2-weighted sequences, DCE MRI, MRS and DW MRI yields higher diagnostic performance for tumor detection and local staging than can any of these techniques alone or even any combination of them. These results suggest that mp-MRI can be used as a triage test among different patient populations, to select patients that can avoid biopsy and those that need re-biopsy before entering an active surveillance program. Time and cost can be saved by using only certain MRI sequences in patients.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Foetal Mri As An Adjunct To Evaluation Of Genitourinary Anomalies: A Single Center Experience99997553010.22034/icrj.2018.75530ENSepideh SefidbakhtShiraz University of Medical ScienceBijan BijanSacramento, CAS BagheriShiraz University of Medical ScienceBita GeramizadehShiraz University of Medical ScienceZ EtemadiShiraz University of Medical ScienceH.R ForootanShiraz University of Medical ScienceM KasraieanShiraz University of Medical ScienceSara HaseliShiraz University of Medical ScienceLobat AtaeiShiraz University of Medical ScienceJournal Article20181026Purpose:<br /> To retrospectively correlate foetal MRI’s performed over the last 5 years in our center with GUT anomalies and correlate the results with post-delivery results.<br /> Material and Methods:<br /> We retrospectively correlated all foetal MRI’s performed over the last 5 years in our center with GUT anomalies and correlated the results with postdelivery results.From a total of 456 foetal MRI’s performed 42 studies (GA=27+/-9 wks) were performed either for evaluation of a GU anomaly seen in ultrasound or had an unexpected anomaly detected in MRI. In 33 patients post delivery confirmation in form of phone calls, national registry search results or operation notes/pathology was available.<br /> Results:<br /> Patients included 8 cases of oligohydramnious sent for evaluation of the kidneys (in 7 out of 8 kidneys were located), 5 cases of suspected ARPCKD, one sacrococygeal teratoma, one ambiguous genitalia, one foetal pelvic cyst. In two patients obstructive uropathy was ruled out with MRI despite mild bilateral pelviectases seen in ultrasound and in 3 out of 13 patients with obstructive uropathy MRI provided additional information including one duplicate collecting system with ureterocele later seen in second look ultrasound and two patients with isolated renal cysts or multicystic dysplastic kidney, and one adrenal hemorrhage. Only MRI correctly identified bilateral UPJO and single kidney in two separate patients. DWI images had limited clinical use in evaluating renal function due to large overlap of normal and abnormal ADC values.<br /> Conclusion:<br /> Foetal MRI can provide additional information in genitourinary anomalies. Second look ultrasound is justified in selected cases.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Extraction Of Left Ventricular Wall Mechanical Indexes Using Four-Dimensional Image Analysis Of Mri, Based On A Nonlinear Hyperelastic Model1001007553110.22034/icrj.2018.75531ENHossein Yousefi-BanaemClinical Research Development Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical SciencesSaeed KermaniIsfahan University of Medical SciencesHamid SaneiIsfahan University of Medical SciencesAlireza DaneshmehrDepartment of Mechanical Engineering, school of Enginreeng, University of TehranJournal Article20181026Purpose:<br /> Cardiac diseases is and will be a leading cause of death in the world. Locating and measuring extent of infarct region by local parameters can used as a computer aided diagnostic tool in cardiac imaging centers.<br /> Methods:<br /> First CMRI data processed blindly by cardiologist to score cardiac wall kinesis. In the following using segmented Cine CMR images, 3D meshed template of LV wall constructed, then by robust weighted normalized mutual information algorithm the sparse points were tracked. Finally, by fitting 3D nonlinear active mesh model to the sparse point displacements, dense motion field was estimated and then local parameters of left ventricle in healthy individuals and infarct patients were calculated. Local parameters include; path length, fractional thickening and strain.<br /> Results:<br /> Local parameters of Left ventricle in 30 individuals were calculated by hyperelastic based active mesh model. Results showed more than 50% reduction in local parameters amplitude in infarct regions. Validation of proposed method has been done by obtained error between estimated point by model and analytical point of synthetic images. Results showed mean RMSE= 0.15 mm for synthetic data and RMSE= 0.17 mm for real data. Fractional wall thickening results revealed more than 20% reduction in infarct regions. Comparison of path-lengths with cardiologist scoring of cardiac wall kinesis showed 78% accuracy.<br /> Conclusions:<br /> Proposed method determined the affected region in all patients. Given the promising results of the proposed method Based on the promising results, the proposed method can be used as a diagnostic aid tool in imaging centers.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Comparison Of Liver Stiffness Determined By Shear Wave Elastography In Morbidly Obese Patients Prior To Bariatric Surgery With Liver Biopsy1011017553210.22034/icrj.2018.75532ENFarnood RajabzadehIslamic Azad UniversityLadan GoshayeshiMashhad University of Medical SciencesToba JamialahmadiMashhad University of Medical ScienceAli JangjooMashhad University of Medical ScienceMohsen NematyMashhad University of Medical ScienceJournal Article20181026Background:<br /> Prevalence of non-alcoholic fatty liver disease is increasing due to the morbid obesity. In severely obese patients, NAFLD is a potentially important indication for bariatric surgery. Liver elastography is a validated diagnostic tool to measure liver stiffness in different liver disease.<br /> Objectives:<br /> We aimed to determine the diagnostic performance of elastography as a non-invasive tool compared to liver biopsy in bariatric surgery candidates.<br /> Methods:<br /> Prospectively, a total of 30 severely obese subjects underwent bariatric surgery with liver needle biopsy during the surgery. Diagnostic accuracy of elastography in determining liver stiffness was determined by ROC curve in SPSS v22. Fibrosis and NASH score were considered as a gold standard. F≥2 and NASH≥7 were addressed as an advanced fibrosis and severe activity.<br /> Results:<br /> Their mean BMI of 45.49±5.67 kg/m2. When fibrosis was as a gold standard the Area Under the Curve (AUC)of [0.82±0.10 (95% CI:0.62-1.0)] resulted from the ROC curve of elastography for this prediction. For a value of 7.05 (optimal cutoff), elastography had a sensitivity and specificity of 80%.when NASH score was as gold standard following results were achieved: AUC of [0.97±0.04 (95% CI: 0.9-1.0)] for this prediction and for a value of 7.25(optimal cutoff),elastography had a sensitivity of 100% and specificity of 88.5%.<br /> Conclusion:<br /> Non-invasive liver stiffness measurement is feasible in severely obese patients using shear wave elastography. Shear wave elastography is useful in clinical evaluation before bariatric surgery.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Primary Breast Inflammatory Carcinoma, Mammographic And Sonographic Findings1021027553310.22034/icrj.2018.75533ENAfsaneh AlikhassiJournal Article20181026Objective:<br /> We aimed to describe the mammographic ad sonographic characteristics of patients with clinical diagnosis of breast primary inflammatory carcinoma.<br /> Materials and Methods:<br /> 31 women participated in our study in 2013 to 2016, all have mammograms and sonography with age range of 36-67 years (mean age, 52 years). Imaging findings of all patients were described and recorded before beginning of treatment.<br /> Results:<br /> They referred with chief complaint of breast enlargement in 26 case (84%), severe pain in 17 patients (55%) and breast skin discoloration in 9 patients (29%). Findings were as follow: skin thickening in 30 patients (96 %), diffusely increased density in 29 patients (93 %), axillary lymphadenopathy in 20 patients (64 %), trabecular thickening in 18 patients (58 %), architectural distortion or focal asymmetric density in 10 patients (32%), nipple retraction in 5 patients (16 %) and suspicious appearing calcifications were seen in 4 patients (13 %)<br /> Conclusion:<br /> Diffuse imaging abnormalities such as skin thickening, trabecular thickening with increased density, and axillary lymphadenopathy are common at presentation of these patients. Masses and suspicious calcifications are less common manifestations of this disease. Adding sonography increases the rate of mass detection in these kind of patients at presentationIranian Society of RadiologyIranian Congress of Radiology2588554534420181201Association Between Common Bile Duct Diameter And Abdominal Aorta Calcium Score1031037553410.22034/icrj.2018.75534ENMorteza SaneiShahidbeheshti university of Medical SciencesSahar AbbasiShahid Beheshti University of Medical SciencesJournal Article20181026Background and Objective:<br /> There is evidence of association between aging and increase in the normal limit of the common bile duct (CBD) diameter. As aging is a documented risk factor for atherosclerosis, and the possible effect that atherosclerosis can have on the CBD diameter via affecting its smooth muscle contractility and blood flow, we decided to determine the association between CBD diameter and atherosclerosis in the abdominal aorta quantified by Agatston score.<br /> Methods:<br /> A total of 99 asymptomatic patients (53 males and 46 females; age range of 18 to 88 years) without history of cholecystectomy who underwent abdominal contrast-enhanced CT scan were included. The CBD diameter was calculated. The atherosclerosis of the abdominal aorta was quantified by Agatston score.<br /> Results:<br /> Mean (±SD) CBD diameter was 6.14 (±1.95) mm; range= 2.4 to 12.7 mm. Agatston score was 0 in 59 patients. In the remaining 40 patients, median (interquartile range, IQR) Agatston score was 497.5 (2026.3). Mean (±SD) CBD diameter in patients with Agatston score > 0 was 7.39 (±2.07) mm compared to 5.29 (±1.32) mm in patients without calcification plaque (P< 0.001). A moderate correlation was seen between CBD diameter and Agatston score (ρ= 0.43; P= 0.005).<br /> Conclusion:<br /> Atherosclerosis of the aorta as measured by Agatston score showed a significant moderate correlation with CBD diameter. Although the exact cause of increased CBD diameter with advancing age is not understood, a general atherosclerotic process which occurs with aging may affect smooth muscle of the CBD. Whether an upper limit for normal CBD should be defined or not when evaluating dilated CBD for patients with subclinical or clinical atherosclerosis needs further studies.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Application Of Quantitative Neuroimaging (Qni) Segmentations In Dementia1041047553510.22034/icrj.2018.75535ENF. HekmatniaSouthend University Hospital, Southend on sea, United KingdomT. YousryQueen Square, University College London, London, United KingdomF. BarkhofQueen Square, University College London, London, United KingdomS. BisdasQueen Square, University College London, London, United KingdomJ. CardosoQueen Square, University College London, London, United KingdomM. WhiteQueen Square, University College London, London, United KingdomS. OurselinQueen Square, University College London, London, United KingdomFarzaneh HekmatniaSouthend university hospitalJournal Article20181026In the current radiological practice, there is no gold standard for the diagnosis of dementia and we are dependent on qualitative visual assessment of images such as visual scores of atrophy. To increase the accuracy of the diagnosis, we aim to generate an automated analysis of grey matter atrophy by segmentation using the software Geodesical information flows (GIF) to give us a quantitative assessment result. The most determining factor when analysing images via this method is the regional volume of the different areas of the brain derived.<br /> Segmentation is routinely used for research purposes at the moment.<br /> There are four stages in this study: credibility, accuracy, management and socio-economic study. The credibility and accuracy studies are presented in this project. In the first stage, the credibility study, T1 weighted images of 20 patients with Alzheimers disease (AD), frontotemporal dementia (FTD) and controls were assessed and run through GIF. In the accuracy study, 47 cases were analysed by two raters, each with and without the segmentation report from GIF.<br /> Overall, a significant relationship was seen between the visual scores and regional volumes. However, no specific pattern was observed in parameters analyses between with and without<br /> GIF segmentation report. The addition of QNI report showed an improvement in the Kappa value in terms of agreement with the pathological diagnosis in both raters.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Acalculous Cholecystitis In Intensive Care Unit Patients: Higher Incidence In Females And Prognostic Role Of Serial Sonographic Findings1051057553610.22034/icrj.2018.75536ENFatemeh HosseinabadiZahedan University of Medical SciencesAidin LotfiazarZahedan University of Medical SciencesJournal Article20181026Background:<br /> Acalculous cholecystitis is a common disability in critically ill patients which has 0.2-0.4% incidence in previous studies. The last researches believe that incidence in men is two to three times as high as women. One of the available and reliable modalities to diagnosis this disorder is sonography.<br /> Patients and Methods:<br /> In this cross-sectional study we evaluated 50 patients admitted to Intensive Care Unit (ICU) of Aliebn-Abitaleb hospital in Zahedan, Iran in 2015. Patients evaluated with portable sonography in early admission time and twice a week (until discharge or death) and biliary sludge, biliary stone, gallbladder edema, biliary tract dilation and radiologic murphy sign detected. Also, demographic data, underlying disease and Liver Function Test (LFT) obtained from the patients. Data analyzed with IBM SPSS version 19 and Fisher exact test and T-Test used to data analysis for qualitative and quantitative variables respectively.<br /> Results:<br /> Twenty-five patients (50%) showed the evidences of the biliary sludge. This incidence for biliary stone, gallbladder edema, biliary tract dilation and radiologic murphy sign was 8 (16%), 2 (4%), 7 (14%) and 0 (0%) respectively. There was a significant relationship between female gender and biliary sludge and biliary distention (P-value < 0.05) and patients had higher incidence of biliary distension in longer admissions (P-value = 0.001). There was no statistically correlation between underlying disease, LFT and demographic data except gender (P-value >0.05).<br /> Conclusions:<br /> Acalculous gallbladder disorders are very common in ICU admitted patients in Iran and should be considered specially in longtime and female ICU admitted patients.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Evaluating The Correlation Between Lipid Level In Mr Spectroscopy And Signal Loss Ratio In Chemical Shift (Ip/Op) Images In Brain Gliomas1061067553710.22034/icrj.2018.75537ENBita AbbasiMashhad university of medical sciencesHadi Zare-SoltaniehMashhad University of medical sciencesBita AbbasiMashhd Azad UniversityMasoud Pezeshki-RadMashhad university of medical sciencesDonya Farrokhmashhad university of medical scienceJahanbakhsh HashemiMashhad university of medical sciencesBehrooz ZandiMashhad university of medical sciencesReza AkhavanMashhad university of medical sciencesJournal Article20181026Introduction:<br /> Gliomas are the most common malignant primary brain tumors. Magnetic resonance spectroscopy has been used for grading these lesions. It has been shown that the amount of free tumor lipid metabolites is a promising indicator to detect aggressive tumors. This method is time-consuming, technically demanding and associated with imaging artifacts in certain parts of brain. It is also not available in all imaging centers.<br /> Assuming that gradient echo chemical shift imaging (In phase / opposed phase) technique is capable of evaluating intracellular lipids, we conducted a study to compare the results of chemical shift imaging and MRS in patients with brain glioma.<br /> Material and Methods:<br /> In this study, 33 patients with a cerebral glioma (18 males and 15 females) with a mean age of 43 years were subjected to MRI imaging test using 1.5 Tesla magnet. Magnetic Resonance Spectroscopy and chemidcal shift sequences were performed in all patients. The MRS spectrum was evaluated to assess the free lipid metalbolites withint the tumor. We also calculated the signal loss ratio in a ROI placed in the solid part of the tumor.<br /> Results:<br /> Spearman’s correlation showed a significant correlation between signal drop in chemical shift imaging and lipid and lipid-lactate levels in MRS (p value < 0.01).<br /> Conclusion:<br /> This study showed a significant correlation between the free lipid level in MRS and signal drop in chemical shift images. Considering the limitations of magnetic resonance spectroscopy, and importance of evaluating the amount of free lipids in brain gliomas regarding tumor staging, we suggest that SLR in IP/OP imaging is a major step towards improving the evaluation of lipid levels in these tumors and is helpful in determining patients’ prognosis and tumor grading.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Peripherally Inserted Central Venous Catheter (Picc) Position In Neonates : Evaluation By Ultrasound1071077553810.22034/icrj.2018.75538ENFatemeh YarmahmoodiRadiology Department,Medical School, Shiraz University Of Medical Siences, Shiraz, IranSeyyed Mostajab RazavinejadAssistant Professor, Neonatal Research Center, Shiraz University Of Medical Siences ,Shiraz ,IranJournal Article20181026Background:<br /> Vascular access has become a very important aspect of care for neonates. The use of peripherally inserted central venous catheters (PICCs) has become common in recent years. Therefore, the aim of study is to evaluate the accurate position of PICCs tip by ultrasound.<br /> <br /> Method:<br /> This cross-sectional study was done on neonates admitted to NICU of hospitals affiliated to Shiraz University of medical sciences of Iran from March 2015 to March 2016. All neonates requiring PICCs due to prematurity or other diseases were entered into this study and 296 newborns had criteria for entering the study. In this study, we used catheter from Vygon Company, PICC was inserted at the patient’s bedside based on sterile conditions and NICU protocol. The neonatal PICC has a tip that terminates at or close to the heart or in one of the great vessels (the superior vena cava or the inferior vena Cava). Chest x ray results were recorded in the form and then, ultrasound results were performed blindly and without knowledge of Chest x ray results by a radiologist to examine the tip of the PICC line. It should be noted that written, informed consent was taken from their parents before this study.<br /> <br /> Results:<br /> The sensitivity and spicifity of ultrasound for location of catheter tip position in the superior vena cava is 98% and 96.6% respectively, and positive predictive value and negative predictive value is 96.2 % and 98.3% respectively. The sensitivity and spicifity of chest x ray for correct length of catheter that placed in correct position was 78% and 68.5% repectively.<br /> <br /> Conclusion:<br /> Our study suggest that ultrasound is the more reliable and safe than chest x ray for the identification of the PICCs position and also detects complication of catheter malposition earlier, and reducing exposure ionization radiation. <br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Evaluation Of The Diagnostic Value Of Diffusion Weighted Magnetic Resonance Imaging In Assessment Of The Fetuses With Intrauterine Growth Restriction1081087553910.22034/icrj.2018.75539ENMahsa KhosraviRadiology resident and associate professor, department of radiology of Shahid Sadoughi hospital, Shahid Sadoughi university of medical science, yazd, IranReza Nafisi MoghadamRazie Sadat TabatabaeeMohammad Hosein AhrarFarimah ShamsiHamideh ForghaniJournal Article20181026Background / Objectives:<br /> Intrauterine growth restriction (IUGR) is defined on the basis of a weight below the 10th percentile for gestational age. placental insufficiency is a major cause of IUGR. Currently, diagnosis of growth restricted fetuses is dependent on ultrasonography. However, it may be too insensitive to detect early placental dysfunction. Diffusion weight MRI (DWI) has been widely used in early detection of tissue ischemia. The purpose of this study is to evaluate diagnostic value of DWI in early diagnosis of placental insufficiency.<br /> Patients and Methods:<br /> In this prospective study, 38 pregnant women with gestational age between 25-40 week, suspected for having growth restricted fetus by obstetrician were evaluated by ultrasonography and DWI of placenta. Fetuses with estimated fetal weight of less than 10th percentile for gestational age based on sonography and birth weight of less than 10th percentile were categorized as IUGR group and others as control group. ADC values (Apparent Diffusion Coefficient) were obtained from two different areas on ADC map of placenta for each case.<br /> Results:<br /> After exclusion of 2 cases due to incompatibility of ultrasound and birth weight findings, 17 fetuses were ultimately categorized as growth restricted and 19 were included in control group. After calculating ADC value by DWI of placenta, mean ADC value of placenta in the IUGR and control group were 1442±197 (mm) ^2/sec and 1643±86 (mm)^2/sec, respectively. ADC values were significantly lower in IUGR fetuses than control group. (P Value < 0.001)<br /> Because of low area under ROC curve, no appropriate cut off point could be determined to have high sensitivity and specificity.<br /> Conclusions:<br /> IUGR is associated with low ADC value and restricted diffusion in placenta but no appropriate cut off point for ADC value could be suggested for early diagnosing of placental insufficiency.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Differentiation Of Adrenal Adenoma From Adrenal Metastasis With Intravoxel Incoherent Motion Model1091097554010.22034/icrj.2018.75540ENSoheil SabetIstanbul Bilim UniversityBedriye Koyuncu SokmenIstanbul Bilim UniversityAyşegül ÖzIstanbul Bilim UniversitySadık ServerIstanbul Bilim UniversityDoğukan SökmenOta & Jinemed HospitalSezgi Burçin BarlasIstanbul Bilim UniversityNagihan InanIstanbul Bilim UniversityJournal Article20181026Background:<br /> Intravoxel incoherent motion is a diffusion weighted imaging method which can characterize the relation between signal intensity and b value. Regarding to this bi-exponential model, IVIM would separate the diffusion of water molecules from micro capillary perfusion of tissues. This technique may estimate the perfusion of tissues without intravenous contrast application.<br /> Objectives:<br /> To investigate the value of IntraVoxel Incoherent Motion (IVIM) diffusion perfusion model for differentiation between adrenal adenomas and adrenal metastasis.<br /> Materials and Methods:<br /> We retrospectively evaluated thirty five adrenal lesions. According to conventional MRI findings, 25 lesions were incidentally detected adenomas and 10 lesions were adrenal metastasis of previously known primary oncologic malignancies. Mean age of all subjects was 61 years (range: 43-81). All patients were examined by 1.5T MRI (Siemens, Magneton Symphony, Erlangen, Germany) with the use of four-channel phased array body coil. In addition to routine pre- and post-contrast sequences, IVIM (16 dif ferent b factors of 0, 50, 100, 150, 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1100, 1200, 1300 s/mm2) and conventional DWI (3 different b factors of 50, 400, 800 s/mm2) were obtained using a free breath single-shot echo planar spin echo (EPI) sequence. The mean D (true diffusion coefficient), D* (pseudo-diffusion coefficient associated with blood flow) and f (perfusion fraction) values also calculated from IVIM. ADC, D, D* and f values were compared between adenoma and metastasis groups by Mann-Whitney U test.<br /> Results:<br /> The f and D values were significantily higher in metastasis group (p<0,05). ADC and D* values of metastatic lesions were significantly lower than those of adenomas (p<0,05).<br /> Conclusion:<br /> IVIM parameters such as f, ADC and D* values can provide significant diagnostic information regarding differentiation of adrenal adenomas and adrenal metastasis, based on different perfusion characteristics.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Comparison Of Qualitative (Time Intensity Curve Analysis), Semi-Quantitative, And Quantitative Multi-Phase 3t Dce-Mri Parameters As Predictors Of Malignancy In Adnexal1101107561510.22034/icrj.2018.75615ENSeyedeh Nooshin Miratashi YazdiEmam khomeini hospitalJournal Article20181027Objective:<br /> The present study aimed to compare the qualitative (time intensity curve analysis), the semi-quantitative and the quantitative multiphase 3T dynamic contrast-enhanced (DCE) MRI parameters as predictors of malignancy in adnexal masses.<br /> Materials and Methods:<br /> In this prospective study, women with an adnexal mass who were scheduled for surgical resection or were followed for more than one-year period to confirm the benignity of their lesions, underwent multiphase 3T DCE-MRI. The qualitative (time intensity curve), semi-quantitative (SImax, SIrel, WIR) and quantitative (Ktrans, Kep, Vb) analyses were performed on DCE-MRI sequences and their predictive values were compared.<br /> Results:<br /> A total of 17 benign and 14 malignant lesions were included. According to the qualitative analysis, none of the lesions with Type I time intensity curves (TIC) were malignant and none of the masses with Type III TICs were benign. The accuracy of the quantitative parameters in detection of malignancy was found to be higher than that of semi-quantitative variables, particularly when calculated for a small ROI within the high signal area of the mass (sROI) rather than the largest ROI including the whole mass (lROI), and when inter-MRI variations were omitted using ratios. The Kep (tumor) /Kep (myometrium) ratio measured from sROI was the best parameter for differentiating a malignant lesion with a sensitivity of 100% and a specificity of 92.3%.<br /> Conclusion:<br /> We concluded that a Type I TIC confirms a benign lesion, and a type III TIC confirms the malignancy and further evaluation is not recommended for these lesions. So complementary quantitative analysis is only recommended for adnexal masses with type II TICs.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Correlation Of Apparent Diffusion Coefficient With Tumor Grade And Ki-67 Proliferative Index Of Meningioma1111117561610.22034/icrj.2018.75616ENSoheil SabetIstanbul Bilim UniversityParviz SamadovMarmara UniversityCemal Aydın GündoğmuşMarmara UniversitySüheyla Uyar BozkurtMarmara UniversityGazanfer EkinciMarmara UniversityJournal Article20181027Background:<br /> Meningioma, the most frequent intracranial, extra-axial tumor, constitutes %13-26 of all intracranial neoplasms. Less than %10 of all meningiomas account for grade II or III (atypical-anaplastic) based on WHO criteria. Preoperative estimation of tumor grade might play a directive role for neurosurgeons. Higher Ki-67 index is associated with increased risk of tumor recurrence affecting the prognosis.<br /> Objectives:<br /> We aimed to investigate the efficiency of diffusion weighted imaging properties in preoperative estimation of tumor grade and correlation between ADC values and Ki-67 proliferative index. To our knowledge this is the largest single tertiary center study series in English literature investigating association between DWI and histopathologic features of meningiomas.<br /> Materials and Methods:<br /> Pre-operative brain MR examinations of 206 consecutive patients were evaluated retrospectively. ADC values of 6 ROI’s in two consecutive slices were measured and the average ADC value was calculated for each lesion. Proliferation activity of the tumors which were identified with ki-67 index was recorded. The meningiomas were classified into low grade (WHO grade I) and high grade (WHO grade II/III) groups.<br /> Results:<br /> Median ADC value in low and high grade lesions were 826.23 ± 134.567 × 10-6 mm2s-1 and 732.48 ± 150.846 × 10-6 mm2s-1 respectively. Threshold of 750.5 × 10-6 mm2s-1 for ADC value, yielded the best sensitivity (%74), specifity (%72) and accuracy (%73.79) in discriminating low and high grade meningiomas. The area under curve in ROC analysis was 0,742. Determination of 750.5 × 10-6 mm2s-1 as threshold ADC value, led to 95.04% and 27.69% negative and positive predictive values, respectively. There was also a significant negative correlation between ADC value and Ki-67 index level (r = - 0,26 , p < 0.001 )<br /> Conclusion:<br /> ADC value is an important parameter in characterization of meningioma with implications for prognosis and management. ADC values can also predict tumor proliferative index providing the advantage of proper surgical approach and further use of fractionated radiotherapy or stereotactic single-dose radiosurgery to decrease the possibility of tumor recurrence.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Pain After Percutaneous Liver Core Needle Biopsy: Comparing The Intercostal And Subcostal Routes1121127561710.22034/icrj.2018.75617ENMasoud PezeshkiradMashhad university of medical sciencesBita AbbasiMashhad university of medical sciencesKhaled HashemiMashhad university of medical sciencesJournal Article20181027Introduction:<br /> Percutaneous liver biopsy is a common procedure worldwide. It is now used as the reference standard for diagnosing most parenchymal liver disease. Pain is a common complication after liver biopsy. It is important to control the pain as much as possible. This is important for patients’ comfort and it also makes the patients cooperative in cases of possible repeated biopsies.<br /> Percutaneous liver biopsy can be performed via subcostal or intercostal routes. It is recommended to perform it via subcostal route whenever possible. this is believed to decrease the complications like pneuomothorax. There are a few studies that evaluated the effect of biopsy access on the patients’ pain and discomfort. In this article we evaluated the pain experienced by patients after needle biopsy of the liver and compared it between subcostal and intercostal approaches.<br /> Material and Methods:<br /> A hundred and twelve patients referred to our clinic for ultrasound guided liver biopsy were randomized into two groups. Percutaneous liver biopsies were performed through subcostal approach in one group and inter-costal approach in the other group. A visual assessment score (VAS) for pain was recored in all patients immediately after the procedure and in the second and fourth hours. The level of anxiety was also evaluated with Spielberger questionnaire immediately before the procedure. The patients were monitored after the procedure for hemorrhage (ultrasound was performed and free fluid or subcapsular hematomas were searched for) and pneumothorax (CXR if there was any complaint of respiratory discomfort).<br /> Results:<br /> A hundred and twelve consecutive patients referred for liver biopsy entered in our study. Core needle biopsy was performed via intercostal route in 54 (48.2%) and via subcostal route in 58 (51.8%) of patients. There were 46 (41.1%) male patients and 66 (58.9%) female patients in our study. The primary outcome of the study was pain that was evaluated using VAS scale in the 0, 2 and 4 hours after the procedure. There was no significant difference in the pain between male and female patients. There was no significant difference in the pain between the intercostal and subcostal group immediately after the procedure (p value: 0.055), but we found a significant difference in pain between these two groups at the second (p value: 0.001) and fourth (p value: 0.001) hours after the procedure.<br /> We also found no significant correlations between the patient’s age and pain at 0 (p value: 0.936), 2 (p value: 0.285) and 4 (p value: 0.617) hours.<br /> We did not find any significant correlation between the level of anxiety and pain at 0 (p value = 0.115) and 4 hours (p value = 0.057), but there was a significant correlation between the level of anxiety and pain at 2 hours post-procedure (p value = 0.017).<br /> Discussion:<br /> The pain after liver biopsy was not statistically different in two groups immediately after the procedure, but the difference was significant in the second and fourth hours after the biopsy. This suggests that all ultrasound guided liver biopsies should be performed via subcostal approach whenever technically feasible. We also should consider continuing the analgesics in patients to whom biopsy has been performed with intercostal approach.<br /> This study did not show any significant difference in pain between males and females. Patients’s age and their anxiety levels were not correlated with the level of pain. There was also no significant difference in pain between patients with parenchymal liver disease and those with focal liver lesion. It seems that biopsy route is the only non-operator factor that influences the level of pain experienced during percutaneous liver biopsy.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Multi-Detector Computed Tomography Evaluation Of Kidneys And Renal Vascular Anatomy In Living Probable Renal Donors1131137561810.22034/icrj.2018.75618ENHidayatullah HamidiFrench Medical institute for Mothers and ChildrenAbdul Basir ShahinFrench Medical institute for Mothers and ChildrenJournal Article20181027Introduction:<br /> Living donor renal transplantation has become major treatment for patients with end-stage renal disease. Preoperative evaluation of potential renal donors is crucial for selecting proper donors and the surgical technique. Multi- detector computed tomographic (MDCT) angiography is a noninvasive technique for preoperative evaluation of potential renal donors. As the practice of renal transplant has recently been started in Afghanistan, therefore authors aimed to look for the variation of renal vasculature, collecting system and other congenital and acquired anomalies.<br /> Objectives:<br /> To evaluate the normal anatomy, congenital variants and acquired abnormalities of kidneys and renal vasculature in healthy afghan population (probable renal donor)<br /> Methodology:<br /> Cross sectional descriptive study has been conducted on probable renal donors who underwent abdominal MDCT at radiology department of French Medical Institute for Mothers and Children (FMIC) from May 2017 to Dec 2017. MDCT images were reviewed for congenital and acquired abnormalities. Consecutive sampling was performed.<br /> Result:<br /> A total of 72 patients (144 kidneys) were included in the study 57 being male and 15 female.<br /> Abnormalities of renal vessels: accessory renal arteries 26 kidneys (18%), early arterial branching 17 kidneys (12%), right accessory renal vein 8 kidneys (6%), late venous confluence 20 kidneys (14%), left retro-aortic renal vein 2 kidneys (1%) and left circumaortic renal vein 2 cases (1%). 1 case had significant renal artery stenosis. Single collecting system was seen in 136 (94) cases and bifid renal pelvis in 8 cases (6%)<br /> Renal Abnormalities:<br /> Simple cysts 4 kidneys (3%), calculus 2 kidneys (1%), and congenital anomalies 3 kidneys (2%) (2 fused horse shoe kidneys, 1 malrotated) 1 cortical scarring and 1 suspected lesion for malignancy.<br /> Significant abnormalities not related to urinary tract: bronchial atresia 1 case, fused lumbar vertebrae 1 case, compressed fracture of lumbar vertebra 1 case and cholecystectomy in 1 case.<br /> Conclusion:<br /> Significant variations are seen in renal vasculature which can be well evaluated by MDCT as a non-invasive imaging approach in probable renal donors.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201The Ratio Of Prenasal Thickness To Nasal Bone Length In Fetal Screening Ultrasonography At Second Trimester Of Pregnancy1141147562010.22034/icrj.2018.75620ENAmirhossein Hashemi AttarDepartment of Radiology, Islamic Azad University, Mashhad BranchMehrnoosh MemarIranian Society of RadiologyJournal Article20181027Introduction:<br /> Chromosomal abnormalities is the cause of more than 50-80 per cent of abortions and the reasons of 4-28 per cent of all mental retardations. Determining the fetal karyotype by chorionic villus sampling and amniocentesis are the gold standard methods for diagnosis of these diseases. Since these procedures are invasive and include at least 1 risk of fetal abortion, in recent years, different screening tests based on sonographic and biochemistry indexes are introduced and developed to determine who needs these invasive diagnostic methods. this study was performed with aim to assess the ratio of prenasal thickness to nasal bone length (PT/NBL) in fetal screening ultrasonography at second trimester of pregnancy.<br /> Methods:<br /> This cross-sectional, analytic and descriptive study was performed on 500 healthy pregnant women with singleton fetus at 15-26 weeks of gestation in 2015. Ultrasound measurements of PT and NBL were performed on a midsagittal plane of fetal face. These measures were recorded in statistical table. Data was analyzed with SPSS software (version22) and Statistica (version10). P Results:<br /> The mean of PT increased from 2.23A +- 0.47 mm at 15 weeks to 4.32A+- 0.9 mm at 26 weeks of gestation (P=0.001). The median of NBL increased from 4A+- 0.17 mm at 15 weeks to 8.35A+- 0.56 mm at 26 weeks (P=0.001). There was a linear relationship between PT and NBL with gestational age. The mean of PT/NBL was 0.5A+- 0.78 which was constant during these weeks (P=0.89).<br /> Conclusion:<br /> Gestational age, maternal age and fetal sex had no influence on PT/NBL ratio (P>0.05). So, this ratio can be used as an independent predictive factor for aneuploidies.<br /> <br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Radiation Protection Principle Observance In The Neonatal Intensive Care Units (Nicu): A Retrospective And Observational Audit At The Main Hospital Of Dezful, Iran1151157562110.22034/icrj.2018.75621ENVahid KaramiDepartment of Basic Sciences, School of Allied Medical Sciences, Dezful University of Medical Sciences, Dezful, IranParvin AbdollahiStudent Research Committee, Dezful University of Medical Sciences, Dezful, IranJournal Article20181027Background:<br /> The conventional radiological procedures are a significant source of radiation to the population. Although patients can benefit from medically indicated x-ray procedures, their use involves some potential health risks. Several published literatures emphasized that the radiation effects are inversely proportional with patients’ age, suggests the high radiation tissue sensitivity of neonate and pediatric patients. Hence, it is imperative that the radiation exposure of neonates is kept as low as reasonably achievable (ALARA). Portable chest x-ray is one of the most common x-ray procedures, frequently requested for the neonates at the neonatal intensive care unit (NICU). Neonatal chest x-ray is contribute to the radiation exposure of ionizing radiations to the several most radiosensitive tissues such as the thyroid gland and breast, colon and this is increased concerns about patients’ safety. There are many dose optimization strategies that can be applied to reduce the patient radiation exposure and some authors have addressed these strategies. Other studies have discussed the rate of their use in clinical practice.<br /> Objective:<br /> The aim of this study was to assess the radiation protection principle observance in the NICU departments at the main hospital of Dezful, Iran.<br /> Methods:<br /> This was a retrospective and observational audit that was conducted in the main hospital of Dezful, Iran. A standard observational check list, recommended by the ICRP, IAEA was used to data collection. Three nursing students were invited and agreed to participate in this audit. After training, the students were sent to NICU departments. The students were asked to attend as an observer in the NICU departments and record the radiation safety principle observance. The blinded of the study was also respected. We also supplemented the observational data with a retrospective survey of the images at the PACS database. We retrieved images of the chest x-rays from August 2017 to December 2017. Each image was reviewed for the probable evidence of protection such as appropriate beam collimation and shielding tools.<br /> Results:<br /> Our data showed that collimating the primary beam to the ROI was regarded in 20% of chest x-rays. Most of the personnel were used of same exposure parameters (42 kVp and 2.5 mAs) and the use of appropriate exposure parameters (high kVp and low mAs) were only regarded in 25% of x-rays. The focus to film distance (FFD) was in the range of 40 to 80 cm. In all, 375 portable chest x-rays were retrieved from PACS database, in which there were no evidence of shielding tools and also most collimations was not satisfactory.<br /> Conclusion:<br /> Our data are commensurate with the previous studies in the literatures and emphasized that adherence to the radiation safety guidelines are seems to be necessary. Although portable chest x-rays expose neonates to very low radiation, however, due to wide frequency, the collective dose may be a reason for concern.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Evaluation Of The Radiographer’s Trust To Film Dosimetry Results In Hamadan University Affiliated Hospitals1161167562210.22034/icrj.2018.75622ENSiamak Sabzevarifarshchiyan sina hospitalKarim GhazikhanloosaniHamadan University of Medical SciencesJournal Article20181027Introduction:<br /> All radiology centers use ionizing radiation. Among the various instruments used to measure radiation doses, thermoluminescence dosimeters (TLDs) and filmbaj are most widely used.<br /> Using the information obtained from the filmBaj, radiation energy can be estimated .<br /> Since the level of trust and awareness of the radiographers is significant to the results of the filmBaj ‘s dosimetry in educational and therapeutic centers, a comprehensive study on this issue has not been carried out at Hamedan province. Therefore, this study was conducted to determine the trustworthiness of the radiographers on the dosimetric results of the filmBaj.<br /> Method and Materials:<br /> In this cross-sectional study, which was carried out at the level of radiology centers of Hamedan-based educational-teaching hospitals in 1394, a researcher-made questionnaire was designed to determine the trustworthiness of radiation workers to the results of the dosimetry of the filmBaj.<br /> To assess the validity of this questionnaire, the content validity index and content validity ratio were used. After collecting the questionnaires, the variables were extracted using descriptive statistics. Descriptive statistics were used to determine the trustworthiness of radiographers to the results of filmbaj dosimetry.<br /> Results:<br /> The content rate got a minimum of 0.85. The study reliability was 0.87. The study reliability was 0.87.<br /> The results of the study indicate that the degree of trust of the radiographers to the filmbaj’s dosimeter results is low (38%). Also, there is no statistically significant difference between the degree of trust of the radiographers with the filmBaj dosimetric results (P = 0.13). Nearly all personnel have responded positively to the option “Their received dose rate does not match the results recorded in the filmbaj.<br /> Conclusion:<br /> The results of this study show the low level of trustworthiness of the radiographers towards the dosimetric results of the filmBaj.<br /> <br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Agreement Of Pop-Q Examination With Pelvic Dynamic Mri In Grading Of Pelvic Organ Prolapses1171177562310.22034/icrj.2018.75623ENArvin ArianDepartment of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences ( TUMS)Maryam Deldar Pasikhani(Department of Obstetrics & Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences ( TUMS ))Zinat Ghanbari(Department of Obstetrics & Gynecology, Imam Khomeini Hospital, Tehran University of Medical Sciences ( TUMS ))Masoumeh GityTehran University of Medical SciencesParto Sabetrasekh(Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences ( TUMS ))Madjid Shakiba(Department of Obstetrics & Gynecology,Imam Khomeini Hospital, Tehran University of Medical Sciences ( TUMS ))Journal Article20181027Background / Objectives:<br /> Pelvic floor disorders(PFDs) include various symptoms and pathologies, make a considerable decrease in quality of life and involve up to 30-50% of middle aged women and their challenging diagnosis is supported by physical examination and imaging including MRI. In this paper, we are going to assess agreement of POP-Q examination with pelvic dynamic MRI in grading of pelvic organ prolapses.<br /> Patients and Methods:<br /> Totally 61 patients with PFD were enrolled [mean age: 52.7±14.3]. All patients were examined by an expert gynecologist and POP-Q grading were determined regarding anterior [bladder neck and urethra], apex[uterus] and posterior[rectum] pelvic organs. All patients underwent dynamic pelvic MRI by a 3T machine based on standard protocols. we considered pub coccygeal(PC) line as reference. MRI grading were included normal, mild, moderate and severe prolapse and manual exam included normal, stage I, stage II and [stages III or IV] in POP-Q. Agreement of two methods was assessed by kappa coefficient.<br /> Results:<br /> In determining of [moderate and severe] and severe prolapses, Kappa agreement were 0.28 and 0.44 in bladder neck respectively. These figures were 0.03 and 0.14 in urethra,0.6 and 0.6 in uterus and 0.05 and 0.1 in rectum. Corresponding concordance rates were %60 and %80 in bladder neck, %31 and %71 in urethra, %83 and %87 in uterus and %62 and %68 respectively. All these figures were lower considering H-line as reference line.<br /> Conclusion:<br /> Agreement of MRI and POP-Q is good in uterus prolapses while it is worse in anterior and posterior prolapses. MRI could be complementary method for POP-Q examination and combination of these two diagnostic methods seems useful.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Diagnostic Performance Of Intravoxel Incoherent Motion Parameters For Response Evaluation After Locoregional Treatment Of Hepatacellular Carcinoma1181187562410.22034/icrj.2018.75624ENSadık ServerIstanbul Bilim UniversitySoheil SabetIstanbul Bilim UniversityEsat Namal(Istanbul Bilim University)Yaman Tokat(Istanbul Bilim University)Nagihan InanIstanbul Bilim UniversityJournal Article20181027Background:<br /> It is possible to obtain the true diffusion coefficient through Intravoxel incoherent motion (IVIM) which reflects cell density and the perfusion fraction indicating the microcirculation of tumors. Therefore, IVIM may reflect tumor behavior resulting from the therapeutic effect of locoregional treatment (LRT) in Hepatocellular Carcinoma (HCC).<br /> Objectives:<br /> To evaluate the diagnostic accuracy of conventional and IVIM-based DWI parameters for assessment of tumor response in patients who had received LRT due to HCC.<br /> Methods:<br /> We included 15 patients with HCC with history of LRT (11 Trans arterial Radioembolization (TARE), 4 Trans arterial chemoembolization (TACE)). In addition to routine MRI sequences, IVIM with 16 different b values varying from 0 to 1300 s/mm2 and conventional DWI with 3 different b factors of 50, 400, 800 s/mm2 were obtained using a single-shot echo planar spin echo sequence before and 6 weeks after LRTs. MR imaging response was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST), modified RECIST (mRECIST), and European Association for the Study of the Liver (EASL) criteria on postcontrast arterial phase MR images. Quantitatively, conventional apparent diffusion coefficient (ADC) and IVIM parameters including mean D (true diffusion coefficient), D* (pseudo-diffusion coefficient associated with blood flow), and f (perfusion fraction) values were calculated before and after LRTs. The differences in these values were analyzed.<br /> Results:<br /> A significant decrease in arterial enhancement was observed according to mRECIST and EASL criteria (-38,43±16,49 and -39,314±31,98, respectively). The ADC and D values after LRTs were significantly higher than those of pre-treatment (p=0.012 and p=0.002) (mean ADC was 1,00±0,21x10-3 mm2/s for before LRTs; 1,46 ±0,37x10-3 mm2/s for after LRTs; mean D was 0,74±0,30x10-3 mm2/s for before LRTs; 1,39±0,31x10-3 mm2/sn for after LRTs). The f values (%) after LRTs was significantly lower than those of before ones (p=0.016) (mean f was 37,61±7,99 for before LRTs; 8,58±2,66 for after LRTs).<br /> Conclusion:<br /> ADC values and IVIM parameters appear to reflect the response of LRTs of HCCs, promising new horizons especially in patients with renal or hepatic insufficiency clinical settings, owing to elimination of contrast media administration. The main limitation of this study is small patient number, necessitating further studies with larger series to provide a consensus on these parameters.<br /> <br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Brain-Included F-18 Fdg Pet/Ct Acquisition Protocol: Clinical Impact Of Newly-Diagnosed Cerebral Metastasis In Extra-Cerebral Cancer Patients Based On Primary Cancer Type1191197562510.22034/icrj.2018.75625ENMehrdad Bakhshayesh KaramNRITLDFarahnaz Aghahosseini(NRITLDFahimeh Tavakoli(NRITLD)Maryam Hassanzad(NRITLD)Journal Article20181027Background:<br /> Evolution of individualized radiosurgical therapeutic methods for brain metastasis as an ominous prognostic finding may encourage a more extensive application of neuroimaging in patients with extracerebral cancer. The aim of the present study was to investigate the added value of brain-included 18 F FDG PET/CT acquisition protocol based on primary cancer type and clinical indication.<br /> Methods:<br /> A retrospective review was performed on 3945 PET/CT reports of patients with extra-cerebral cancer underwent brain-included PET/CT study. Cerebral lesions suggestive of brain metastasis were subsequently verified by MRI, MRI+MRS, surgical pathology and a 1-year clinical formal follow up. The detection rate of new brain metastasis and related impact on disease status were then investigated in each cancer type based on clinical indication.<br /> Results:<br /> Of a total 3933 eligible patients, 44 (1.12%) were finally verified to have new cerebral metastasis. The most common primary sources were lung cancer (19/385, 4.93%), cancer of unknown primary (CUP) (5/168, 2.97%) and breast cancer (8/468, 1.71%). The lowest detection rate of new cerebral metastasis was found in lymphoma (2/859 [0.23%]). The most common clinical indications were initial staging (17/44, 43.1%) and restaging (19/44, 36.4%). Change in disease status occurred in 12 out of 44 patients (27.3%), more frequently occurred in lung cancer (n=4), in all indications and breast (n=3) cancers at restaging (n=7, 43.8%).<br /> Conclusion:<br /> PET/CT acquisition protocol study may be best optimized based on the type of primary cancer and timing of evaluation. Brain-included field of view may be recommended for lung cancer regardless the clinical indication, cancer of unknown primary and breast cancer at restaging. Skull-based protocol is best suited for lymphoma.Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Combined Effect Of Oral Famotidine And Cimetidine On The Survival Of Lethally Irradiated Mice; An In-Vivo Study1201207562610.22034/icrj.2018.75626ENKarim Afsar(Babol University of Medical Sciences)Ali Shabestani MonfaredCancer Research Center, Babol University of Medical Sciences, Babol, IranAbolfazl Razzagdoust(Shahid Beheshti University of Medical Sciences)Hossein Mozdarani(Deptartment of Medical Genetics, School of Medical Sciences, Tarbiat Modares University)Ali Naeiji(Radiology Technology Department, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran)Journal Article20181027Background:<br /> The radiation damages could be repaired, but some of these damages which fail to repair could result in cell death or mutation. The induced damages could be modulated by radioprotectors. Cimetidine and famotidine belong to antagonists to the histamine H2 receptor which their efficacy in protection against radiation was studied, but, their effectiveness in oral administration and the combination of famotidine and cimetidine is not studied yet. The aim of this study was the assessment of combined effects of famotidine and cimetidine on irradiated mice survival.<br /> <br /> Materials and Methods:<br /> 270 male NMRI mice were provided and divided into 11 major groups including sham control. Some of these groups were divided into more than one subgroup. The study groups were irradiated with the doses of 6, 7, 8, 9 Gy and were treated with the doses of 2, 4 and 8 mg/kg famotidine, 10, 20 and 40 mg/kg cimetidine and the combination of both. Then, their survival fractions, as percentages of mice who survived until 30 days, were measured.<br /> <br /> Results:<br /> The LD50/30 for radiation alone was determined as 7.47 Gy. By treating the mice with a concentration of 4 and 20 mg/kg for famotidine and cimetidine, respectively, the survival fraction of animals was significantly higher than the LD50/30 group. The combined regimen of famotidine+cimetidine in radioprotection had higher DRF than each of them, separately but this difference was not statistically significant. The DRF of combined, famotidine, and cimetidine groups were 1.09, 1.08, and 1.01 respectively.<br /> <br /> Conclusions:<br /> Our results are implying that the combined regimen of famotidine+cimetidine in radioprotection had not a significant higher DRF than each of them separately, and we did not find a synergic effect in combined oral famotidine and cimetidine on irradiated mice.<br /> <br /> <br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Accuracy Of Color Doppler Sonography In Diagnosis Of Carpal Tunnel Syndrome1211217562710.22034/icrj.2018.75627ENReza JalliShiraz University of Medical Sciences, ShirazBanafsheh Zeinali-RafsanjaniMedical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IranMahdi Saeedi-MoghadamMedical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IranJournal Article20181027Introduction:<br /> Carpal Tunnel Syndrome (CTS) is the most common upper extremity impingement neuropathy caused by median nerve compression within the carpal tunnel due to various conditions such as bone abnormalities, inflammation, trauma, neoplastic lesions and endocrinopathies.<br /> Increase in carpal tunnel pressure of more than 20 to 30 mmHg blocks the epineural blood flow, so the nerve function is damaged.<br /> CTS is primarily a clinical diagnosis that is supported by electrodiagnostic studies, in recent years different imaging modalities, including MRI and ultrasound, have been suggested for diagnosis of CTS.<br /> <br /> Materials and Methods:<br /> During November 2011 till May 2013, 84 patients who were clinically suspicious for CTS were enrolled in our study (age of patients ranging from 19 to 66 years old with the average of 43years and sex ratio of female to male was 2.7: 1) .All of the patients underwent ecterodiagnostic tests (EDT) as the gold standard diagnostic modality and results of color Doppler sonography (CDS) were compared with electerodiagnostic findings.<br /> <br /> Results:<br /> According to the EDT, patients with positive results of CTS were divided into three groups of severity including; mild CTS with 9 patients(11%), moderate with14 cases (17%) and severe CTS with 18 patients (21%of total cases).Sensitivity of CDS for diagnosis of CTS was almost 83%, 71% and 55% in severe, moderate and mild cases of CTS respectively. Specificity of this imaging modality was determined near to 80% in three groups of the patients.<br /> <br /> Conclusion:<br /> In addition to ecterodiagnostic tests, which are considered as the modality of choice for diagnosis of CTS, Doppler ultrasound can be a non-invasive imaging procedure for evaluation of patients that are clinically suspicious to this condition. Considering three groups of CTS based on severity of electerodiagnostic signs, results of CDS is more reliable in severe patients.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Evaluating The Relation Between Apparent Diffusion Coefficient, Lesion Enhancement Pattern And Severity Of Disease In Patient With Brain Stroke1221227562810.22034/icrj.2018.75628ENLeila Nasiri-Sefat(Medical Imaging MSc Candidate, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.)Fariborz Faeghi(Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran )Ahmad Mohammadbeigi(MSc Student of Medical Physics, Students Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.)Hamid Reza HaghighatkhahShahid Beheshti University of Medical SciencesFarzad Ashrafi(Associate Professor of Medical Imaging. Clinical MRI Physicist, PhD in Medical Physics-Emphasis: Medical Imaging-Fellow of fMRI and Diffusion from Italy.)Amir Rezaei(Neurology Ward, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.)Journal Article20181027Introduction:<br /> The stroke disease leads to some problems in normal brain diffusion. Thus, DWI can be used in the early diagnosis of this disease, especially in acute phase. Acquired ADC maps from DWI show the water molecule diffusion. These maps are used as a biomarker to detect different types of stroke. We investigated the relationship between signal amplification pattern of lesion and stroke intensity according to the size of the lesion in patients with ischemic stroke in the middle cerebral artery.<br /> <br /> Materials and Methods:<br /> We included 30 patients (12 females and 18 males) in our study. By using the Onis software, patients were divided into three groups (<5cm3, 5-15cm3 and 15cm3<), based on the lesion volume. The mean ADC was determined by using ADC maps. The relationship between the mean ADC and the NIHHS score, and NIHHS score with the volume of the lesion was determined. A quantitative model and a qualitative-visual model were used to determine the intralesional patterns in the ADC maps. Also, we used the ROC curve for analyzing the diagnostic value of ADC mean and determining the quantitative threshold to define the intralesional pattern.<br /> <br /> Results:<br /> There was a strong correlation between stroke intensity and lesion size in patients with large lesion size (P = 0.001, r =0.753). There was no significant relationship between the severity of stroke (NIHSS score) and mean ADC (P = 0.724, r = -0.067). Also, the ROC curve indicates that if the standard deviation of ADC of an individual is greater than 1.82*10-3 s /mm2, it is a heterogeneous lesion. We also found a weak agreement (k = 0.03) between two quantitative and qualitative-visual model. <br /> <br /> Conclusion:<br /> This study showed that ADC maps and stroke intensity can be used to predict stroke volume. Additionally, we could specify intralesional pattern by ADC maps. <br /> <br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Assessment Of The Amount Of Basal Ganglia Iron Deposition In Patient With Parkinson’s Disease Using Quantitative Susceptibility Mapping (Qsm)1231237562910.22034/icrj.2018.75629ENVahid Shahmaei(Shahid Beheshti University of Medical Sciences, Tehran, Iran)0000-0002-7857-7315Fariborz Faeghi(Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran )Ahmad Mohammadbeigi(MSc Student of Medical Physics, Students Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.)Journal Article20181027Studies have demonstrated that increased brain iron concentration is associated with Parkinson’s disease. Parkinson’s is the most common degenerative neurological disorder after Alzheimer’s disease. Many studies have shown some imaging techniques can measure the amount of iron deposition in the brain as a biomarker for Parkinson’s prognosis. Research have shown that Quantitative Susceptibility Mapping (a technique based on echo gradient imaging) has more sensitivity than T2-weighted imaging, T2* and R2* mapping. A few studies have been done to evaluate the amount of iron in the nuclei of the basal ganglia of brain (Red Nucleus, Sub stantia Nigra, Caudate, Globus, Putamen, Thalamic) in Parkinson’s disease. Therefore, it seems necessary to investigation of this method and assessment the relationship between stage of disease, age, gender and diagnostic value of this method. Therefore, our goal in this study was to measure the concentration of iron deposition in the basal ganglia by two methods of QSM and measurement iron content and comparing the diagnostic value of these methods in every nucleus, separately.<br /> <br /> Methods:<br /> Number of 30 patients with Parkinson’s disease were examined by a neurologist and were categorized at three different stages. Hoehhn and Yahr tests was used for the staging of patient. Number of 15 healthy individuals were considered as control group. The routine brain sequences and the QSM special sequence were performed by the SIEMENS MAGNETOM TRIO 3T system. The SPIN software was used to processing and analyzing the images. The images were processed using three filters: BET, SHARP, Inverse Filter, and a high pass filter. Then using QSM images were overlaid on the MP-RAGE sequence images. Finally, the susceptibility of each nucleus was measured separately with the available tool. To analyzing, we used SPSS version 18 and regression, correlation coefficient and ROC curve.<br /> <br /> Results: <br /> The sixteen percent of subjects were male and 40% were female. The mean age of patient and control group was 66.2 and 63.7 years, respectively. There were 8, 11 and 11 patients in stage 1, 2 and 3, respectively. There was a significant difference between control and patient groups in magnetic susceptibility mapping (QSM) of sub stantia, red nucleus, and globus pallidus nuclei. The highest iron deposition was found in red cores, globus pallidus and substantia nigra, but there was no significant difference between the control group and the patient. The association between age with QSM was significant in the nucleus of globus pallidus (r = 0.305, P = 0.042). The relationship between the stage of the disease with QSM was significant in globus pallidus, red and substantia nigra nuclei. The correlation between age and iron content just in the globus pallidus nucleus was statistically significant. The relationship between the stage of the disease and the iron deposition in the nucleus of globus pallidus and substantia nigra was significant. Iron deposition with QSM has correlation in substantia nigra, red nucleus, putamen, globus pallidus, thalami and Caudate nuclei. We also obtained the Sensitivity, Specificity, and accuracy for both QSM and iron content for all six nuclei, separately.<br /> <br /> Conclusion:<br /> The QSM is a good choice for the detection of pathologic changes in patients with PD. QSM can identify the patient signature of PD, and its discrimination between patients with PD and controls is highly accurate, Specially in substantia nigra, red nucleus globus pallidus. Also, QSM can be used to staging the PD. Our findings suggest that QSM may be valuable for the diagnosis and assessment of PD.<br /> <br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201The Association Between Gestational Age And Amniocentesis Complications1241247563010.22034/icrj.2018.75630ENAmirhossein Hashemi AttarDepartment of Radiology, Islamic Azad University, Mashhad BranchShamim Rahiman(Department of Radiology, Islamic Azad University, Mashhad Branch)Fatemeh Hafezi(Department of Radiology, Islamic Azad University, Mashhad Branch)Journal Article20181027Background and Objective:<br /> Amniocentesis for prenatal diagnosis is usually performed at 15 to 20 weeks of gestation. Early amniocentesis in the first trimester is associated with increased risk of fetal loss. However, the correlation between gestational age (GA) and incidence of complications after mid-trimester amniocentesis is unclear. The aim of this study was to evaluate whether there is a relationship between GA and complications of second-trimester amniocentesis or not.<br /> <br /> Patients and Methods:<br /> From 2005 to 2015, a total of 1555 second-trimester amniocentesis in singleton pregnancies were included. Exclusion criteria were induced abortion, abnormal amniocentesis results, maternal underlying disease or uterine malformations, fetal anomaly or abnormal findings in fetal ultrasound, and in vitro fertilization. All cases underwent follow-up for at least 1 month, and amniocentesis-related complications, including fetal loss (spontaneous abortion), vaginal bleeding, and amniotic fluid (AF) leakage were recorded. Patients who were not available for follow-up were also excluded.<br /> <br /> Results:<br /> A total of 1276 amniocentesis were studied. The mean maternal age and GA were 33 + 6.5 years and 17.2 + 2.3 weeks, respectively. No Complication occurred in 98% of cases. Overall, fetal loss rate was 0.7% (n=9), vaginal bleeding occurred in 1% (n=13), and AF leakage was detected in 0.3% (n=4). Among pregnancies with GA less than 17 weeks (n=719), a total of 15 complications (2.1%) occurred including 6 fetal loss, 6 vaginal bleeding, and 3 AF leakage. On the other hand, in pregnancies with GA of 17 weeks or more (n=557), a total of 11 complications (2%) were recorded, including 3 fetal loss, 7 vaginal bleeding, and 1 AF leakage. Comparing the two groups (GA< 17 and GA> 17), there were no statistically significant difference in cumulative complication rate (2.1% vs 2%, P= 0.889), and incidence of fetal loss (0.8% vs 0.5%, P= 0.739), vaginal bleeding (0.8% vs 1.3%, P= 0.456), or AF leakage (0.4% vs 0.2%, P= 0.636).<br /> <br /> Conclusions:<br /> There is no association between amniocentesis-related complications and GA, based on the findings of our study. Therefore, second-trimester amniocentesis can be safely offered to pregnant patients, regardless of GA, without increased risk of adverse events.<br /> <br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Scoliosis For Well-Being Bmd1251257563110.22034/icrj.2018.75631ENJalal Jalal ShokouhiAli Akbar KhademJournal Article20181027Introduction and Material and Methods:<br /> 35 cases of lumbar spine with scoliosis showed normal BMD during patient evaluation with osteopenia or osteoporosis by femoral neck and distal radius BMD’s. in case of severe osteoporosis even by aged patient’s scoliosis forms spinal BMD normal or lower degree of osteopenia in lumbar.<br /> <br /> Result:<br /> Except drug as medical treatments, food and nutrition: exercise and sport or back school may improve spinal BMD in direction of increasing bone mineral.<br /> Statistics from 35 patients with BMD and mal- alignment of lumbar spine are available. BMD reporting by radiologist leads to more attention in morphology and related valuable information.<br /> BMD is prepared for 561 women and 103 men. More numbers for women was 50-70-year-old for men was 67-year-old.<br /> By Stress analysis of the model using of CAD/CAM software show the same result with our clinical result.<br /> Iranian Society of RadiologyIranian Congress of Radiology2588554534420181201Imaging Manifestations Of Posterior Reversible Encephalopathy Syndrome Following Hematopoietic Stem Cell Transplantation In Pediatric Patients1261267563210.22034/icrj.2018.75632ENSoheil KoorakiAmir Reza RadmardAmir Ali HamidiehAmir Pejman Hashemi TaheriMelina HosseinyMaryam BehfarMohammad BabaeiArdeshir GhavamzadehJournal Article20181027Purpose:<br /> To investigate the incidence and various imaging features of posterior reversible encephalopathy syndrome (PRES) in pediatric patients following hematopoietic stem cell transplantation (HSCT).<br /> <br /> Materials and Methods:<br /> This prospective study was carried out between March 2014 and June 2016 on all pediatric patients after HSCT. All patients who developed neurologic symptoms underwent Brain MRI (1.5 T magnet, Avanto, Siemens), which included DWI and SWI sequences. In those with the diagnosis of PRES, a follow-up MRI was conducted within 2 months. <br /> <br /> Results:<br /> A total of 254 post-HSCT patients were enrolled (160 males, mean age:7.6±4 years), These patients included 65 individuals with thalassemia, 41 with fanconi anemia, 59 with lymphoma/leukemia and 89 with other miscellaneous disorders. Twenty-three patients (9.1%) were diagnosed with PRES based on clinical findings and MRI results. The incidence of PRES was markedly higher in those with fanconi anemia compared to those with other diseases (p value: 0.004). MRI showed asymmetric edema in 10 patients. The most common imaging pattern was Superior frontal sulcus distribution (34.8%), followed by holo-hemispheric(26.1%), dominant posterior(26.1%) and partial(13%) distributions. Foci of microhemorrhage were noted in five patients. Of these five patients, two died shortly after PRES, while three patients had persistent microhemorhagic foci in follow-up exam with another patient dying later after a second episode of PRES<br /> <br /> Conclusion:<br /> PRES is highly prevalent in pediatric patients after HSCT, especially in those with underlying fanconi anemia. A large percentage of individuals with PRES have atypical imaging findings. A minority of individuals’ experience Hemorrhagic PRES, which is possibly associated with a worse prognosis.<br />