Tehran University Medical Journal

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Twenty cases of isolated optic neuritis (15 female, 5 male) were studied and followed for several months to years after the initial attack. The mean age of patients was 23 years (range: 15-29 years). The most frequent clinical manifestations were decreased visual acuity and blurred vision. A complete neurological examination was performed. In 15 cases (75%) the initial brain MRI was abnormal. In fourteen cases, other signs of multiple sclerosis presented in one month to eight years following the initial attack of optic neuritis eleven of the latter cases had an abnormal initial MRI. Acute optic neuritis can be considered a presenting feature of multiple sclerosis, particulary in the presence of an abnormal brain MRI.

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Background: Patellofemoral joint disorders are the most common cause of anterior knee pain in patients who referred to orthopedic clinics. Patellar lateralization cause anterior knee pain due to weakness of vastus medialis oblique muscle or tightness of lateral structures like lateral retinaculum or iliotibial band muscle.

Materials and Methods: For evaluation of this abnormality, plane radiography, CT scan and MRI are useful. In plane radiography only one view in a single joint position can be obtained, because of that it is not a good method to detect abnormal tracking during knee range of motion. The purpose of this study was to evaluate patellar tracking by kinematics MRI during five serial degrees of knee range of motion (40, 30, 20, 10, 0 degrees) in 30 patients with patellar lateralization and 10 normal subjects, aged 18-30 years.

Results and Conclusion: tistical analysis showed that in patients group, patella had the most stability in 40 degree of knee flexion and this stability reduced when knee reached to full extension. At this point, patella moved laterally and the most instability was seen during 20 to 0 degree of knee extension.

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Background: Multiple sclerosis (MS) is a chronic disease that begins most commonly in young adults and is characterized pathologically by multiple areas of central nervous system (CNS) white matter inflammation, demyelination, and glial scarring. The most valuable aid for diagnosis is magnetic resonance imaging (MRI). New type of MRI has been developed on the basis of molecular diffusion which capable of detecting acute and active lesions. Early diagnosis and treatment is possible to stop or slow down progression of disease. The aim of this study is to compare the findings of conventional and diffusion- weighted (DW) MRI in detection cerebral lesions of MS.

Methods: Thirty patients with clinically definite MS and 30 healthy volunteers were studied in a descriptive-prospective survey over a twelve-month period of time. Conventional and DW MRI were used in both groups. Total number, morphology, location and the mean size of the intra-cerebral plaques of MS were compared between group. The sensitivity and the specificity of both imaging methods in detecting these plaques were determined.

Results: Thirty patients with MS with the mean age of 32.76±8.79 years and 30 healthy individuals with the mean age of 32.75± 9.23 years were enrolled. Plaque within the brain was significantly higher by the conventional method (P< 0.05). Ovoid lesions were greater in number in the conventional method group. More lesions were detected by the conventional method in the areas of periventricle, centrum semiovale and corpus callosum. Regarding the size of plaque, the minimum measurement was significantly lower in the conventional method group. The sensitivity of both methods was 100%. The specificity of conventional and DW MRI was 86.6% and 96.6%, respectively.

Conclusion: In our study the sensitivity of both methods was the same but the specificity of DW MRI was higher. DW MRI may detect lesions which are not detectable by the routine methods.

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Background: Imaging abnormalities in the paranasal sinuses are regularly noted as incidental findings on MRI, however, little is known about their prevalence in the Iranian population. The purpose of this study was to classify these findings in the paranasal sinuses as seen on MRI and to investigate the prevalence, according to site and type of paranasal abnormality.
Methods: In this cross-sectional study, the T2-weighted axial MRI of 256 patients with diseases unrelated to their paranasal sinuses were reviewed between May 2002 and June 2003. The findings were categorized according to the anatomic location and the imaging characteristics of the abnormality. The abnormalities recorded included total sinus opacification, mucoperiosteal thickening >5mm, air fluid levels and retention cysts or polyps. Unilateral or bilateral involvement and septal deviation were also noted. A sinus was considered normal if it was fully aerated and no soft-tissue density was apparent within the cavity.
Results: Among our cases, 111 (43.5%) were male and 145 (56.5%) were female. Of these patients, abnormalities in one or more of the sinus groups were found in 110 subjects (42.9%), 55.5% of which were male and 44.5% were female (P=0.001). Maxillary sinus abnormalities were observed in 66.4% of the patients, while ethmoid sinus abnormalities were found in 63.6%. Of the ethmoid abnormalities, 21% were found in the anterior section, 9% in the middle ethmoid, and 8% in the posterior ethmoid. The most common abnormality found was mucosal thickening. Among our cases, 23.4% had septal deviation, which was significantly higher among those with sinusitis (29% versus 19.1% P<0.01). Of those patients with sinus involvement, 16% were involved in the sphenoid sinus and 5% in the frontal sinus. The results obtained from the patients with sinus abnormality revealed that 85% suffered from cough, nasal obstruction, runny nose, facial pain and post nasal discharge and 24% had been diagnosed with chronic sinusitis by physician.
Conclusion: Our results showed that there was a high rate of incidental abnormalities in the paranasal sinuses that are unrelated to the patient's presenting problems.

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Background: The knee is the most commonly injured joint. The internal components of the knee include the meniscuses, the anterior cruciate ligament (ACL) and posterior cruciate ligaments (PCL). Magnetic resonance imaging (MRI) is now used widely because of its high accuracy and noninvasiveness. Our objective was to diagnose internal knee component injuries by MRI and compare its diagnostic value with that of arthroscopic surgery.
Methods: This process research study was carried out between May 2004 and September 2006 on 90 randomly selected patients admitted to the orthopedic ward of Baghiatollah Hospital, Tehran, Iran. Each patient had arthroscopic surgery after undergoing MRI by an expert radiologist.
Results: Out of 90 patients, 81 were male and nine were female. The mean age was 31.6 years (range: 17-71). Among patients with normal ACL as shown by MRI, 42.4% were shown by arthroscopy to have a ruptured ACL. The sensitivity and specificity of MRI in ACL abnormalities were 73% and 77%, respectively. Only 1.3% of the patients with normal PCL by MRI showed PCL rupture upon arthroscopic examination. The evaluation of the lateral meniscus by MRI had a sensitivity and specificity of 40% and 94%, respectively. Likewise, in the medial meniscus, sensitivity and specificity by MRI was 70% and 98%, respectively.
Conclusion: According to our study, considerable differences exist between MRI reports and arthroscopic findings in the diagnosis of internal knee injuries. We therefore conclude that sole reliance on MRI reports is not reasonable for making treatment decisions and MRI should be used as just one of the diagnostic tools, in conjunction with other methods, such as physical examination and arthroscopy.

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Gliomas include a group of primary central nervous system (CNS) neoplasms with characteristics of neuroglial cells (eg, astrocytes, oligodendrocytes). The gliomas are classified commonly to WHO grade I-IV gliomas. The grading is based on the presence of nuclear atypia, vascular proliferation, mitoses, and necrosis. The malignant gliomas are progressive brain tumors that are divided into anaplastic gliomas and glioblastoma based upon their histopathologic features. Today, different modalities such as surgery, radiation therapy (in the form of external beam radiation or the stereotactic approach using radiosurgery) and chemotherapy have been used for the treatment of gliom's tomors but unfortunately the prognosis and survival rate is poor in most of patients. The survival depends on the tumor's type, size, location and the patient's age. We reviewed the prognostic factors, diagnostic modalities and surgical management of patients with gliomas.

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Background: There are multiple diagnostic methods for evaluation of patients with low back pain with a radicular pattern, each one has it's own accuracy and diagnostic ability and so comparing them with each other would help the clinicians to find the best diagnostic method. The main objective of our study was to compare the diagnostic accommodation of electromyography (EMG) and Magnetic Resonance Imaging (MRI) findings in patients with low back pain and radiculopathy.

Methods: In this descriptive cross-sectional study, 101 patients with low back pain and radiculopathy attending to Sina Hospital in Tehran, Iran from 2007 to 2009 that had indication for both EMG and MRI were evaluated for their demographic characteristics and disease-related factors.

Results: Totally, 90 out of 101 patients (89%) had abnormal EMG findings and 94 out of 101 subjects (93%) had abnormal MRI results. The concordance rate was 88% (89 patients) with no significant difference (p> 0.05). The sensitivity and specificity of MRI were 95.6% and 27.3%, respectively, and the sensitivity and specificity of EMG were 91.5% and 60%, respectively.

Conclusion: According to the results of this study and in comparison with other studies it may be concluded that MRI and EMG are both accurate and use of them in a concomitant manner would result in increased diagnostic ability in patients with low back pain and radiculopathy.

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Background: Unlike quantified MRI, no correlation has been stated between radiologic findings and the clinical signs in patients with knee osteoarthritis. This study evaluates the relationship between quantified clinical signs including pain, restriction of movement, stiffness and structural changes with MRI and plain radiography findings. Methods: Eighty patients with knee osteoarthritis were successively recruited in the study in Rasole Akram Hospital from 2009 to 2010. Upon physical examination, quantified scales of pain and joint stiffness and limitation of movement were recorded and quantified findings of MRI and plain x-ray were reported during the paraclinical study. All the gathered data including the demographic characteristics of the participants were read to the statistical software. Results: In MRI study, pain was significantly correlated with knee effusion (P=0.008), osteophytes (P=0.006), meniscal degeneration (P=0.036) and subchondral cysts (P=0.044) as was joint stiffness correlated with chondral lesions (P=0.020) and meniscal degeneration (P=0.026). On the other hand, there were no relationship between pain and joint stiffness or limitation of movement in radiologic studies but significant relationships existed between radiologic findings with bone marrow inflammation (P=0.015), chondral lesions (P=0.022) and subchondral cysts (P=0.014). Conclusion: As shown in this study, MRI findings including chondral lesions, subchondral cysts and bone marrow inflammation were correlated with radiologic findings and osteophytes, subchondral cysts, joint effusion and meniscal degeneration were correlated with pain as were meniscal degenerations and chondral lesions were with joint stiffness. On the other hand, clinical findings (pain, stiffness and limitation of movement) had no correlation with radiologic findings.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: The aim of this study was to evaluate the mid-term outcomes of concurrent total correction of Tetralogy of Fallot (TOF) after pulmonary valve (PV) replacement and its relation to QRS duration and MRI results.
Methods:  In this study, 51 patients with TOF who had the TOF surgery and PV replacement enrolled the study. Demographic data, MRI results such as, right ventricular end diastolic volume, right ventricular end systolic volume, systolic and diastolic indexes noted. Moreover, QRS duration and the patients' cardiac functional class were evaluated immediately before and 6 months after the surgery.
Results:  From 51 patients, 27.5% were female and 72.5% were male. The mean age of participants was 23.48 (SD=5.82) years. Functional class changes were statistically different (P<0.001) comparing the status before and after the surgery. The mean QRS duration before surgery was 130.20 (SD=16.89) ms which was in significant contrast with post-surgical states, 122.45 (SD=16.90) ms (P<0.001). Mean QRS duration before and after surgery was statistically lower in asymptomatic patients (P=0.028 and P=0.025, respectively). There was a statistical relationship between pre-surgical systolic and diastolic indexes to post-surgical functional class as asymptomatic patients had lower systolic and diastolic indexes (P=0.005 and P=0.028, respectively).
Conclusion: This study demonstrated that QRS duration before and after surgery can be an indicator to evaluate the cardiac function after surgery for Tetralogy of Fallot. Moreover, systolic and diastolic indexes are factors affecting the good prognosis of patients therefore, PVR surgery needs to be done before the deterioration of systolic and diastolic indexes and cardiomegaly.

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Background: Finding an acute brain lesion by diffusion-weighted (DW) MRI upon an episode of transient ischemic attack (TIA) is a predictor of imminent stroke in the near future. Therefore, exploring risk factors associated with lesions in DW-MRI of the brain is important in adopting an approach to TIA management. In the current study, we tried to determine the risk factors associated with lesions in DW-MRI of the brain in patients experiencing TIA episodes.
Methods: Fifty patients with TIA were recruited consecutively in Sina Hospital, Tehran, Iran, over a 6-month period between July 2008 and January 2009. All of the patients underwent a complete neurological examination and laboratory tests. Brain DW-MRIs were performed for all the patients within 72 hours of a TIA episode.
Results: DW-MRI revealed an acute lesion in 16% of the participants. There was a significant correlation between presence of an acute lesion in DW-MRI and TIA duration, history of diabetes mellitus and presence of unilateral facial palsy (P=0.0003, P=0.02 and P=0.008, respectively). Other variables such as age, hypertension, hyperlipidemia, past history of TIA, headache, vertigo, and sensory or visual disturbances had no significant relation with the presence of an acute lesion in DW-MRI.
Conclusion: Duration of TIA, presence of diabetes mellitus and unilateral facial palsy are risk factors for an acute lesion in DW-MRI, meaning that patients with such risk factors are at risk for stroke in the near future.

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Background: Prostate cancer is the third leading cause of death and is the most common cause of cancer in elderly men. Regarding to the low accuracy of screening methods such as prostate-specific antigen (PSA), Digital Rectal Examination (DRE) and trans rectal ultrasound (TRUS) in detection and localization of tumor, Magnetic Resonance Imaging (MRI) and Diffusion Weighted Imaging (DWI) attracted many attentions in the past years. DWI reveals micro-molecular diffusion, which is the Brownian motion of the spins in biologic tissues. This technique can delineate pathologic lesions with high tissue contrast against generally suppressed background signal. In this paper, the value of DWI in detection of prostate cancer is studied.
Methods: In this cross-sectional study, the studied population are suspicious patients to prostate cancer based on high Prostatic Specific Antigen level or abnormal Digital Rectal Examination who refered for prostate biopsy to radiology department of Hazrat-e- Rasoul Hospital during the year 2011. The results of DWI are compared to biopsy results for all patients.
Results: Eighty five patients are selected. The DWI sensitivity in detecting of prostate cancer is 100%, specificity 97.1% and positive and negative predictive values are 89.5% and 100%, respectively. The results showed that if DWI reports the prostate cancer as negative, the result was highly reliable and if it reports as positive, although the report was not 100% reliable, but it still had high reliability, more than 90%.
Conclusion: DWI had high accuracy in detecting prostate cancer for patients with cancer. Also the accuracy of this method for patients without prostate cancer was acceptable compared to the other common methods.

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Background: The request for lumbosacral MRI in Iran  based on previous studies is high (almost half of all MRI cases), so, our study is concerned with investigating the necessity of lumbosacral MRI request in patients with low back pain that is covered by  complementary health insurance in Tehran through comparing  MRI practice with valid guidelines.
Methods: Information of 274 complementary insured patients at Dana Insurance Company in Tehran, who had undergone low back MRI was studied. A portion of information in the questionnaire including age, sex, the physician’s field of specialty, and MRI report, was derived from the medical records. Other information based on guidelines indications, including duration of the prolonged back pain, record of associated infection, malignancy or trauma, saddle anesthesia, lower limb motor deficit and incontinence of urine or feces, was elicited from patients orally.
Results: Males represented 35% and females 65% of patients. Also, males were on average 10 years younger than females. Over 90% of MRI scans were requested by three fields of specialty (orthopedic, neurosurgery and neurology). Considering the indications of lumbar spine MRI request (prolonged back pain of more than one month duration, incontinence of urine or feces, lower limb motor deficit, saddle anesthesia, recent related trauma, infection and malignancy), approximately 20% of lumbar spine MRI scans were prescribed in accordance with guidelines.
Conclusion: Out of every five cases of lumbar spine MRI, four cases were not requested based on guidelines, suggesting needs for local guideline design and revising the manner in which MRI scans are prescribed for low back pain in complementary health insured patients in Tehran.

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Background: This study investigated compatibility between post chemoradiation magnetic resonance images and histologic findings after operation and chemoradiation in patients with locally advanced rectal cancer.

Methods: In this prospective study, 63 patients referred to Cancer Institute of Emam Khomeini Hospital, Tehran, Iran, from October 2011 to October 2013 with locally advanced rectal cancer receiving neoadjuvant chemoradiation (50.4 Gy external beam radiation with concomitant capecitabine 825 mg/m2 PO twice a day with or without 60 mg/m2 oxaliplatin weekly). Patients had an MRI before chemoradiation and MRI assessment were used to identify Tumor (T) and lymph node (N) staging by an experienced radiologist. Patients were recommended to repeat MRI after surgery but it was not obligatory. Findings of post chemoradiation MRI and histopathologic reports were compared. Downstaging was defined as at least one stage decrease in T or N in histopathologic report comparing to their first MRI, on condition of no sign of disease progression.

Results: 32 patients (50.79%) had T downstaging and 36 of them (57.14%) showed N downstaging: none had disease progression. In this study MRI had an accuracy of 55.5% for rectal tumor (T) restaging after chemoradiation comparing to pathology. MRI sensitivity for T restaging was 33.3% to 83.3%.  There was a higher possibility to have errors in restaging of T1-2 stages. Specificity of MRI for T restaging was higher than its sensitivity, 66.6%. In this study lymph node involvement (N) was determined according to morphology and size. MRI has an accuracy of 42.8% for detecting lymph node involvement. Its sensitivity and specificity for N restaging were 50% and 66.6% respectively. All patients had MRI before chemoradiation, although 21 of them repeated MRI after chemoradiation since it was not mandatory. 19 of these 21 patients underwent surgery.

Conclusion: Although MRI is a suitable imaging for staging locally advanced rectal cancer its use for restaging after chemoradiation is under question. According to this study, MRI accuracy rates for both T and N restaging were below the rates of previous studies.

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