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Prevalence of abnormal brain CT- scan findings in patients with headache: two year study in Imam Khomeini Hospital
Saberi H, Zohrei H.r, Abdollahi A. R,
Volume 65, Issue 10 (1-2008)
Abstract

Background: Headache is one of the most common problems that bring patients to doctors' offices. Many physicians order neuroimaging studies after taking the history of the patient and performing a physical examination. These neuroimaging studies are often requested due to the probable existence of an intracranial lesion. However, at times they are requested to allay the fears of patients or even doctors. Most of these studies are normal and the question arises whether there is any indication for requesting neuroimaging studies for a patient with an isolated headache.

Methods: We studied 146 patients with headache who had been referred for CT scan to the imaging center of Imam Khomeini Hospital during 2004-2005. For each patient, a questionnaire, including the medical history and accompanying neurological symptoms, was filled out and CT scan results were gathered.

Results: The mean of age of the patients was 37.8 years, and 69% were female. Only 10 patients (6.8%) had a brain lesion in the CT scan. Accompanying neurological symptoms were more frequent in patients with abnormal rather than normal CT scans. There was a meaningful correlation between abnormal CT scan and paresthesia, ptosis, paresia, diplopia, visual loss, convulsion, vomiting and vertigo. A statistical correlation existed between gender and positive CT scan.

Conclusions: Many patients with headache have normal brain CT scan results. Thus, better criteria are warranted for requesting neuroimaging including accurate patient history and neurological examination in order to prevent unnecessary radiation exposure. MRI instead of CT scan would be a better first step toward the evaluation of the possible existence of brain lesions.


Designing a new CAD system for pulmonary nodule detection in High Resolution Computed Tomography (HRCT) images
Parsa Hosseini M, Soltanian-Zadeh H, Akhlaghpoor Sh, Jalali A, Bakhshayesh Karam M,
Volume 70, Issue 4 (7-2012)
Abstract

Background: Lung diseases and lung cancer are among the most dangerous diseases with high mortality in both men and women. Lung nodules are abnormal pulmonary masses and are among major lung symptoms. A Computer Aided Diagnosis (CAD) system may play an important role in accurate and early detection of lung nodules. This article presents a new CAD system for lung nodule detection from chest computed tomography (CT) images.

Methods: Twenty-five adult patients with lung nodules in their CT scan images presented to the National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Tehran, Iran in 2011-2012 were enrolled in the study. The patients were randomly assigned into two experimental (9 female, 6 male, mean age 43±5.63 yrs) and control (6 female, 4 male, mean age 39±4.91 yrs) groups. A fully-automatic method was developed for detecting lung nodules by employing medical image processing and analysis and statistical pattern recognition algorithms.

Results: Using segmentation methods, the lung parenchyma was extracted from 2-D CT images. Then, candidate regions were labeled in pseudo-color images. In the next step, some features of lung nodules were extracted. Finally, an artificial feed forward neural network was used for classification of nodules.

Conclusion: Considering the complexity and different shapes of lung nodules and large number of CT images to evaluate, finding lung nodules are difficult and time consuming for physicians and include human error. Experimental results showed the accuracy of the proposed method to be appropriate (P<0.05) for lung nodule detection.


Assessment of the diagnostic capability of ultrasound in early diagnosis of nephrolithiasis: a feasibility study
Seyed Hamed Jafari, Mahshid Manuchehrinasab, Mahdi Saeedi Moghadam , Banafsheh Zeinali Rafsanjani ,
Volume 80, Issue 5 (8-2022)
Abstract
Background: CT is the gold standard method for diagnosing kidney and urinary tract stones. This imaging technique delivers radiation dose to patients, which increases the risk of cancer, especially in patients who need frequent assessment. The aim of this study was to compare the diagnostic ability of ultrasound in Iran compared to CT for diagnosing kidney stones in patients with colic pain.
Methods: The data of this cross-sectional retrospective study was gathered from the patients who were admitted to a University-affiliated hospital, Shiraz University of Medical Sciences from March 2019 to September 2019 suspected of nephrolithiasis and performed CT were collected along with their ultrasound reports. To compare sonography and CT, sensitivity, specificity, and positive and negative predictive values were calculated and the diagnostic percentage difference between the two modalities was evaluated. The diagnostic efficiency of ultrasound in stones of different sizes and locations was also evaluated.
Results: The sensitivity, specificity, and positive and negative predictive values of ultrasound in the initial diagnosis of stones were 83.47%, 62.15%, 85.94% and 57.58%, respectively. Ultrasound diagnosis was not significantly different from CT p=23 actually ultrasound diagnoses were different from CT in only 2.11% of cases. Ultrasound was the most successful in detecting bladder and urethra stones larger than 10 mm.
Conclusion: The results of this study showed that although ultrasound is less sensitive than CT in the diagnosis of nephrolithiasis, the use of ultrasound could be useful as a primary diagnostic test in patients with suspected nephrolithiasis. The important point is that the strategy of starting the evaluation with ultrasound, and performing additional imaging if necessary, leads to a reduction in the radiation dose of patients with nephrolithiasis. These patients have to do this procedure many times to diagnose and follow up the disease and clearly the offered method leads to reduction of the radiation absorbed dose and the possible effects of radiation, which is in line with the principle of ALARA, the basic principle of radiation protection.

Sporadic pulmonary lymphangioliomyomatosis (LAM) in a 24-year-old female: a case report
Shahram Seyfi, Nazli Farnoosh, Kayvan Latifi, Parviz Amri Male , Hamed Mehdinezhad Gorji , Asadollah Shakeri, Khadijeh Ezoji ,
Volume 80, Issue 11 (2-2023)
Abstract
Background: Sporadic lymphangioleiomyomatosis (S-LAM) is a rare disease that generally affects young women and involves the abnormal proliferation of smooth muscle cells (LAM cells) in the lungs (pulmonary LAM). There are two types of LAM, sporadic and LAM with tuberous sclerosis, which is an autosomal dominant genetic disease caused by mutations in the Tsc1 and Tsc2 genes. The most common manifestation of this disease is pneumothorax due to cyst rupture. Median transplant-free survival for pulmonary LAM is 23 years from diagnosis. Factors associated with a poor prognosis are often those associated with a more rapid decline in lung function.
Case Presentation: The patient was a 24-year-old woman who presented with pneumothorax and multiple bullae in both lungs. The patient had no family history of respiratory disease, and the patient herself had no symptoms other than mild shortness of breath following activity from a year ago. A lung CT scan was performed for the patient and multiple bullae were evident in both lungs, which confirmed the diagnosis. There was no evidence of involvement of other organs but the lung. For the patient in the ICU with the diagnosis of left pneumothorax, a chest tube was inserted and she underwent mechanical ventilation. Finally, after 24 days of hospitalization, oxygen therapy of the patient was performed with a normal mask, and she underwent left lung pleurodesis with talcum powder, and a few days later, right lung pleurodesis was performed on the patient. On the 36th day of hospitalization, her general condition improved and she was discharged from the ICU. The patient was discharged in good general condition and had no problem on her four months follow-up.
Conclusion: Fortunately, with the diagnosis of LAM for the patient according to the CT scan of the patient's lung, she was treated with insertion of a chest tube and by performing pleurodesis, the recurrence of pneumothorax was prevented. In a young woman with spontaneous pneumothorax, sporadic LAM is one of the differential diagnoses.

Influencing factors in the comparison of renal stone size measurements between CT scan and ultrasound
Mohammad Reza Sasani , Leila Fazlollahpour , Mahdi Saeedi-Moghadam ,
Volume 81, Issue 5 (8-2023)
Abstract
Background: Ultrasound is widely used to detect renal stones. A no-contrast CT scan is the most accurate modality for stone examination. Considering that determining the size of a stone is the main criterion in treatment planning, the purpose of this study was to compare ultrasound and non-contrast CT scans in determining renal stone size.
Methods: In this cross-sectional study, 140 patients were assessed from June to October 2017 at Namazi Hospital of Shiraz University of Medical Sciences. A radiologist compared the CT scans of patients with their ultrasound images. The ultrasound and CT scan results in terms of stone size were assessed. The correlation rate of stone size in ultrasound and CT scans in different subgroups was assessed by categorizing the stone size into three subgroups. The impact of stone location and the CT window on measuring stone size were evaluated.
Results: The mean stone size measured by ultrasound and CT scan was 11.23±5.26 and 9.48±4.7mm, respectively, which was significantly different. The highest rate of correlation was observed in the stones>10mm (81%) and then in 5-10mm (69.3%). The lowest agreement was observed in stones <5mm (37.5%).
Conclusion: Using ultrasonography as a screening test or a primary test for detecting the renal stones is recommended. However, considering the importance of a precise assessment of stone size in choosing the treatment method and the limitations of sonography in the evaluation of small stones, a CT scan should be considered as a standard diagnostic tool if there is no contraindication. In CT images, the application of BW might underestimate the stone size in comparison to SW. Considering the results of previous studies, it is better to use magnified BW to assess the stone size on CT scan images. Although the axial view in a CT scan is more routine, for measuring the stone size it is better to use coronal or sagittal views together with axial views.

Evaluation of nodule incidence as findings of lung involvement in Covid-19 infection and its comparison in three CT scan centers of Shiraz
Razieh Behzadmehr, Ariana Rasekhi , Banafsheh Zeinali-Rafsanjani , Alireza Rasekhi,
Volume 81, Issue 5 (8-2023)
Abstract
Background: Several typical and atypical findings have been observed in Covid-19 high-resolution computer tomography (HRCT). To our knowledge, there is no study investigating the relationship between the presence of nodules in Covid-19 patients and the patient's condition. Therefore, the present study assessed the frequency of pulmonary nodules in Covid-19 patients according to their condition.
Methods: This cross-sectional study assessed the medical images of the patients referred to three university-affiliated centers (Nemazi, Ali Asghar and Shahid Faghihi Hospital) to perform Covid-19 HRCT from April to September 2020. The centers have been named H1, H2, and H3. Patients who were referred to these centers had good, poor, and fair conditions, respectively. The history of patients was assessed carefully. Patients' demographic information, nodule shape, number, size, location, presence of cavitation, and GGO around the nodule were assessed and recorded.
Results: Overall, 20576 patients (mean age=46.75±16.64 years old) were included in the study. Only 2.1% of cases had solid nodules. Most of them (96.76%) were accompanied by a GGO (halo sign), and only 10.42% were associated with a cavity. The good condition, patients showed significantly more solid nodules (3.46%) than others. In size of the nodules in good-condition patients (1.8 cm) is significantly larger than in fair-condition (1.22 cm) or poor condition patients (1.15 cm). 79.86%, 12.5%, and 7.64% of nodules were multiple, dual/triple, and single, respectively.
Conclusion: The frequency of nodules in the HRCTs of good-condition patients was significantly higher than in fair- or poor-conditionpatients; they also had more multiple and larger-sized nodules. The Pearson-coefficient test also revealed a small negative correlation between the presence of nodules and the patient's condition. It seems the presence of nodules indicates higher immunity to viral infections. In the follow-up, it was revealed that people who had nodules were not hospitalized in the ICU. Further study is needed to prove this point.

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