Fatty Infiltration in Multifidus Muscles and its Association With Spinal MRI Findings

Background: The present cross sectional study was conducted to evaluate the relation between fatty infiltration (FI) in multifidus muscles and spinal MRI findings among patients who referred to Sina Athar and Kosar imaging centers of Shahid Beheshti University of Medical SciencesMethods: Discovertebral and facet joint degenerative changes, intervertebral foraminal narrowing, disk herniation and central canal stenosis in all lumbar levels and FI in multifidus muscles at the level of L5 vertebra were assessed on magnetic resonance imaging (MRI) studies of 333 patients, and correlation of these MRI changes with FI was identified.Results: Among 333 patients (174 female), whose data were analyzed, 316 patients mentioned a positive history of back pain. We observed a significant relation between female sex and higher age with degrees of multifidus FI in L5 level. No significant association was found between the existence of back pain and the rate of multifidus FI. There was a significant negative relation between the activity level and the amount of multifidus FI. Considering weekly exercise level and hours of computer use, this association was not observed. Evaluating the relation between end plate and facet joint degenerative process and also neuroforaminal stenosis with multifidus FI, a statistically significant relation was noted. This correlation was not observed for central canal stenosis.Conclusion: We concluded that the degree of multifidus FI was remarkably higher in female gender, older ages and subjects with more sedentary lifestyle. Moreover, a significant correlation existed between abnormal MRI imaging findings (degenerative process, discopathies, foraminal stenosis) and multifidus FI

A Rare Case of Type II Odontoid Fracture With Bilateral Vertebral Arteries Occlusion Without Neurological Deficits

Cervical spine fractures are common fractures due to spine trauma. Odontoid fracture is responsible for 20% of cervical spine fractures. Vertebral artery injuries (VAIs) had widely focused in this setting due to its occurrence with upper cervical fractures. In our case of study, a 42-year-old female presented in the hospital’s emergency department with a history of cervical spine injury without neurological deficits. In further investigations, cervical spine X-ray, magnetic resonance imaging (MRI), and angiography were done to evaluate the possible injuries to the bone, spinal cord, and vascular structures surrounding the spine that eventuated in the accidental diagnosis of bilateral vertebral artery occlusion. This case of the study demonstrated the importance of diagnostic investigations that can evaluate in an emergency department and bilateral vertebral artery occlusion without neurological symptoms due to collateral arteries establishment

Evaluating the Origin of the Brain Metastatic Tumors by Using DWI Parameters

Background: Brain metastases are the most common tumors in the human central nervous system (CNS), with an occurrence 10 times higher than primary brain tumors in adults. A radiologist usually diagnoses these tumors. Typically, magnetic resonance imaging (MRI) has been used to evaluate the status and number of metastases, the design of surgical treatment or radiotherapy, and the response to treatment. This study aimed to consider the origin of metastatic tumors of the brain using diffusion-weighted imaging sequence.Methods: In this study, 95 lesions observed in 51 patients with different types of brain metastasis who analyzed with standard brain MRI protocols such as T2-weighted fast spin-echo in sagittal, coronal and axial planes and T1-weighted spin-echo sequences before and after injection of contrast enhancement and diffusion-weighted imaging. The diffusion-weighted imaging included an echo-planar spin-echo sequence with two b values (0,1000 s/mm) and calculated apparent diffusion coefficient (ADC) maps. We measured the ADC-value on normalized ADC maps and compared them with different methods. ANOVA was used to compare ADC among all groups as well as T-test for every two groups.Results: The results showed that patients with lung cancer (squamous cell carcinoma, SCC) had the lowest mean ADC (658.70*10-3 mm2/s) and breast cancer patients with the highest mean ADC(935.52*10-3 mm2/s). This study demonstrated that most Brain metastases had low and intermediate ADC values. The analysis showed no significant difference among all groups. However, ADC values in breast cancer and kidney and lung (adenocarcinoma) were statistically higher in comparison to other groups. There were no critical discrepancies between ADC values in brain metastases from Breast cancer and lung cancer (adenocarcinoma) and kidney.Conclusion: It seems that evaluating the origin of the brain metastatic tumors by using diffusion imaging (DWI) parameters could be helpful to prevent invasive methods like biopsies in some situations. Although it needs more studies to achieve this purpose

Treatment of Great Saphenous Vein Insufficiency by Endovenous Laser Therapy: Clinical Description and Short Term Follow up of 20 Iranian Patients

INTRODUCTION: Endovenous Laser Therapy (EVLT) for Greater Saphenous vein (GSV) insufficiency is a newly established method of treatment only recently made availablein Iran. The present study seeks to describe the results of the first 20 patients treated with EVLT at Shohada-e Tajrish Medical Center, Tehran, Iran.METHODS: 20 patients (16 male, 4 female) with the mean age of 38.9 and an average length of symptoms of 5.9 years, were treated with a 980-nm laser diode under local anesthesia. CEAP classification (Clinical Severity, Etiology, Anatomy, Pathophysiology) and AVSS scores (Aberdeen Varicose Vein Symptom Severity Score) were used to determine disease severity and symptoms before and after the procedure. Outcome was measured by the rate of recurrence as shown in Doppler ultrasonography evaluation.RESULTS: The mean procedure time was 49 minutes, and the mean admission time was 1.1 days. A success rate of 85% percent was recorded at 6-12 months of follow up. The patients showed a significant reduction in AVSS and CEAP scores (PV=0.0001), Pain (PV=0.00001), Parasthesia and Edema (PV=0.001).CONCLUSION: EVLT seems promising as a novel method of treatment for GSV insufficiency in the Iranian population with many advantages, including higher success rates in comparison with conventional methods of treatment

The CT-Based Patient Specific Hip Joint 3D-Modeling; Potential to Correct the Alignment

Background: The salvage proximal femoral osteotomy is performed in mild or moderate osteoarthritis when the articulating surfaces are normal and relieves the subject’s pain. Because the importance of angular mal-alignment of the femur bone at the hip junction accurate pre-op planning based on patient specific anatomy is required to prevent any lower limb misalignment and joint problem pre-operative.Methods: In this study a CT-Based modeling technique was used to generate a 3D model of the patient’s hip and proximal femur. The registration stage using angio-fluoroscopy was performed to calculate the proximal femur kinematic and input it into a finite element model to achieve the stress distribution pattern of femuroacetabular joint.Results:From finite element model the stress distribution on the articulating surface at the contact zone was analyzed. The result was showing the maximum stress of 1.1 MPa at the contact surface where femur contact the acetabulum. The maximum stress is found in line with mechanical loading of the lower limb.Conclusion: Use of a non-invasive 3D modeling method will remediate the surgical approach in pre-op stage. The in-vivo modeling and assessment of the patient femoroacetabular contact has performed. It has been shown that the accuracy of the proposed model is comparable with the existing surgical pre-op planning

Effective Treatment of Cervical Lymph Node Metastasis of Breast Cancer by Low Voltage High-Frequency Electrochemotherapy

Electrochemotherapy (ECT) is a new local treatment method for solid and superficial tumors. During this new technique, patients experience an unpleasant sensation and slight edema. Most unpleasant and painful is mainly attributed to muscle contractions provoked by high amplitude and low repetition frequency pulses. Recently, we showed that electrochemotherapy using low voltage and higher repetition frequency (LVHF ECT) is an effective tool for inhibiting tumor growth and inducing cell permeabilization. Low voltage high-frequency electrochemotherapy was developed and optimized in vitro and in vivo which and can be used in the clinic. In the present study, we report a case of cervical lymph node metastasis of breast cancer treated by the technique. In our case, LVHF ECT was successful in reducing the size and palliating the symptoms of cervical lymph node metastasis in clinical conditions, whereas other approaches were inefficient. Our electrochemotherapy technique shows good clinical results. However, more studies on this new method are necessary to prove that LVHF ECT can be considered as a standard treatment modality

Hepatic Artery Aneurysms as a Rare but Important Cause of Abdominal Pain; a Case Series

Hepatic artery aneurysm (HAA) is the common visceral aneurysms with the highest reported rate of rupture. The clinical manifestations depending on the size of the aneurysm include epigastric pain, obstruction of biliary tract, rupture and death. Imaging modalities like computed tomography (CT) scan and CT-angiography have a valuable role in the early detection of HHAs. Complications and selecting appropriate treatments depending on the size and location of the aneurysms. This article aimed to report clinical presentation, imaging finding and treatment of some patients presenting with HAAs to emergency department

The Role of Diffusion Weighted MRI in Differentiation of Malignant from Benign Ovarian Tumors

Introduction: Ovarian masses are common and due to the risk of dissemination, biopsy is not recommended before surgery; thus, imaging techniques can play a crucial role in differentiating benign from malignant lesions. Diffusion weighted magnetic resonance imaging (DW-MRI) is now considered a part of the standard evaluation of pelvis. The aim of this study was to investigate the role of DW-MRI in distinguishing between benign and malignant ovarian tumors and its comparison with pathology results. Materials and Methods: In this descriptive analytic study, 85 non-pregnant women of childbearing age with an ovarian mass who were referred to Imam Hossein hospital in 2018 were evaluated. All patients underwent MRI before surgery and apparent diffusion coefficient (ADC) value was calculated for each. In addition, demographic data and postoperative pathology results were recorded. The acquired data were then entered into the SPSS software for statistical analysis. Results: The mean age of the participants was 39.01 ± 6.98 years. Mean ADC value was calculated as 1.14 ± 0.67 × 10-3 mm2/s. Mean ADC value was significantly lower in malignant lesions compared to borderline and benign ones (P<0.001). There was a significant inverse relationship between ADC values and malignancy (r= -0.841, P<0.001); the higher the ADC value, the lower the probability of malignancy. Mean ADC value was the highest in cysts and the lowest in metastatic lesions (with the exception of serous cystadenocarcinoma (P=0.267) compared to other types of lesions (P<0.05). The optimal cutoff point for ADC to differentiate between benign and malignant ovarian lesions was 1.16 × 10-3 mm2/s with 95% sensitivity, 100% specificity, 100% positive predictive value (PPV), 98% negative predictive value (NPV), and 99% accuracy. Conclusions: ADC value in DW-MRI is highly sensitive and specific in differentiation between benign and malignant ovarian tumors.&nbsp

Gonadal vein tumor thrombosis due to renal cell carcinoma

Renal cell carcinoma (RCC) had a tendency to extend into the renal vein and inferior vena cava, while extension into the gonadal vein has been rarely reported. Gonadal vein tumor thrombosis appears as an enhancing filling defect within the dilated gonadal vein anterior to the psoas muscle and shows an enhancement pattern identical to that of the original tumor. The possibility of gonadal vein thrombosis should be kept in mind when looking at an imaging study of patients with RC