Publications by authors named "Hadi Rokni Yazdi"

28 Publications

  • Page 1 of 1

Balloon-occluded antegrade transvenous obliteration of rectal varices: A case report.

Radiol Case Rep 2021 Nov 29;16(11):3363-3368. Epub 2021 Aug 29.

Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Science, Tohid Squre, Tehran, 1416753955, Iran.

Patients with liver cirrhosis frequently experience rectal variceal bleeding subsequent to portal hypertension. Unlike gastroesophageal variceal bleeding, a well-established guideline does not exist in terms of management of bleeding rectal varices. A 75-year-old male with non-alcoholic-steatohepatitis induced cirrhosis presented with a 3-day history of severe rectorrhagia. Considering patient's clinical history, TIPS was not performed and thus, a novel endovascular technique termed balloon-occluded antegrade transvenous obliteration was considered. Under conscious sedation, an occlusion was made through balloon catheter by sclerotic agents including air/sodium tetradecyl sulfate/Lipiodol. After the procedure, and in the 6 months follow up period the patient's hemodynamic status was stable and he recovered without any serious complications. Balloon-occluded antegrade transvenous obliteration is a feasible and safe modality for treating rectal varices bleeding and could be used as an alternative approach in patients with contraindications to traditional treatments.
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http://dx.doi.org/10.1016/j.radcr.2021.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408555PMC
November 2021

Percutaneous Sclerotherapy with Bleomycin and Ethiodized Oil: A Promising Treatment in Symptomatic Giant Liver Hemangioma.

Radiology 2021 Aug 17:204444. Epub 2021 Aug 17.

From the Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (N.A.Y., M.M.M., H.R.Y.), Hepatobiliary and Liver Transplantation Division, Department of General Surgery (H.D.), and Liver Transplantation Research Center (M.N.T.), Imam Khomeini Hospital, Tehran University of Medical Sciences, Qarib St, Keshavarz Blvd, Tehran 14194, Islamic Republic of Iran; and Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran (R.P.).

Background Percutaneous sclerotherapy with bleomycin has been proven to have a potential benefit in the management of low-flow venous malformations. Liver hemangiomas are considered low-flow venous malformations. Thus, percutaneous sclerotherapy could potentially have a promising result in their management. Purpose To investigate the feasibility, efficacy, and safety of percutaneous sclerotherapy with bleomycin in the management of symptomatic giant liver hemangioma (GLH). Materials and Methods This single-institute prospective study was conducted between September 2018 and July 2020. Percutaneous sclerotherapy was performed using a mixture of bleomycin and ethiodized oil under guidance of US and fluoroscopy in participants with GLH who were experiencing related abdominal pain or fullness. Technical success was recorded. Change in symptom severity, according to visual analog scale (VAS), was considered the primary outcome of the study. Volume change, based on the lesion volume at CT, and complications, based on the classification of the Society of Interventional Radiology, were regarded as secondary outcomes. The primary and secondary outcomes were recorded 6 and 12 months after the procedure. Comparison was performed by using the Wilcoxon signed-rank test or paired test. Results Twenty-eight participants (mean age, 45 years ± 9; 25 women) were evaluated. Technical success was 100%. The mean VAS score was 8.3 before the procedure, which decreased to 1.4 (84.7% reduction) and 1.5 (83.5% reduction) at 6- and 12-month follow-ups, respectively ( < .001 for both). All participants reported relief of symptoms (17 of 28 participants [61%] with complete relief; 11 [39%] with partial relief) at 12-month follow-up. Mean GLH volumes dropped from 856.3 cm to 309.8 cm (65.7% reduction) and 206.0 cm (76% reduction) at 6- and 12-month follow-ups, respectively ( < .001 for both). No major complications were detected. Conclusion Percutaneous sclerotherapy is a safe and feasible method with promising results in the treatment of patients with symptomatic giant liver hemangioma. Clinical trial registration no. NCT03649113 © RSNA, 2021 See also the editorial by McGahan and Goldman in this issue.
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http://dx.doi.org/10.1148/radiol.2021204444DOI Listing
August 2021

Successful vascular interventional management of superior mesenteric vein thrombosis in a patient with COVID-19: A case report and review of literature.

Radiol Case Rep 2021 Jun 24;16(6):1539-1542. Epub 2021 Mar 24.

Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, Iran.

Coronavirus disease (COVID-19) is associated with thrombosis formation in various vessels, including those in the abdomen. In this case report, we present a COVID-19 infected patient who had developed abdominal discomfort. The patient underwent magnetic resonance imaging, which showed signs of thrombosis formation in the superior mesenteric vein (SMV). After conservative treatment failed, the patient was considered for vascular intervention. The SMV clot underwent thrombolysis via the infusion of reteplase (dose 6 mg stat, followed by 1 mg every hour) through a 5F perfusion Cather (Cragg-McNamara, 20 cm). Control venography showed near-complete recanalization. The patient was discharged with oral anticoagulants. Our case report is one of the first incidents of successful vascular intervention in SMV thrombosis in the setting of COVID-19.
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http://dx.doi.org/10.1016/j.radcr.2021.03.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988470PMC
June 2021

Intractable parastomal bleeding in a portal hypertensive patient managed by direct sclerotherapy: a case report.

Gastroenterol Hepatol Bed Bench 2020 ;13(1):90-94

Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center(ADIR), Tehran University of Medical Sciences, Tehran, Iran.

Patients with a stoma have 5% chance of developing parastomal varices, which tend to repetitive massive and life-threatening hemorrhages. Treatment of choice in parastomal varices have not been established, while Transjugular Intrahepatic Portosystemic Shunt (TIPS) has been revealed as the most successful measure. We report a hemodynamically unstable patient with a history of Ulcerative Colitis (UC) and Primary Sclerosing Cholangitis (PSC) with colostomy, because of colon cancer who presented with massive parastomal bleeding. Non-operative treatments and TIPS failed to control the symptoms. Color Doppler ultrasound showed a hepato-fugal flow. The direct antegrade technique, using Sodium Tetradecyl Sulfate (STS 1%) and glue-Lipiodol, was applied under ultrasonography guidance, and complete stoppage of bleeding was achieved. No immediate or late complication or follow-up recurrence were noted after 8 months. In case of hepatofugal flow, direct percutaneous mesenteric parastomal venous access and sclerotherapy is a rapid and relatively safe procedure for parastomal variceal bleeding.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069542PMC
January 2020

Application of Microwave Ablation for Treating Pulmonary Adenocarcinoma: A Case Report.

Tanaffos 2017 Jun;16(4):304-308

Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Pulmonary metastases occasionally do not respond to chemotherapy and surgery. Moreover, some early stage cancer patients, who are candidates for surgery, are unable to tolerate surgery. In such cases, microwave ablation is a convenient alternative for tumor eradication. Microwave ablation has low morbidity and mortality rates compared to traditional cancer treatments. Moreover, the lower procedural cost, potential to perform treatment in an outpatient setting, and repeatability are beneficial aspects of this technique. Herein, we report an adenocarcinoma case that was potentially unsuitable for surgery and was treated with percutaneous microwave pulmonary tumor ablation in August 2015 at the Bronchoscopy and Laser ward of the Shahid Beheshti Medical University, Iran.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971762PMC
June 2017

Percutaneous Sclerotherapy for Giant Symptomatic Liver Hemangiomas: A Pilot Study.

J Vasc Interv Radiol 2018 02;29(2):233-236

Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

This single-center prospective trial evaluated the safety and efficacy of percutaneous sclerotherapy for liver hemangiomas in 5 patients (1 man, 4 women; mean age 41.2 y) between 2016 and 2017. All patients were symptomatic (4 abdominal pain; 1 early satiety) and refused surgery. A single session of sclerotherapy with 20 cc mixture of 45 IU. Bleomycin in 10 cc distilled water and 10 cc Lipiodol (Ultra Fluide, Guerbet, France) was performed in all patients, achieving a 45.6%-71.1% lesion volume reduction and a 12.9%-41% reduction in the largest diameter of the lesion. Symptoms subsided in all patients during the 5-month follow-up period. Adverse events included a self-limited intraperitoneal hemorrhage in 1 patient.
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http://dx.doi.org/10.1016/j.jvir.2017.10.009DOI Listing
February 2018

Percutaneous Transhepatic N-Butyl Cyanoacrylate Injection Therapy of an Isolated Bile Duct Associated with a Bronchobiliary Fistula.

J Vasc Interv Radiol 2016 Jun 3;27(6):930-2. Epub 2016 Jun 3.

General Surgery, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1016/j.jvir.2016.02.024DOI Listing
June 2016

The relationship between total mass and blood supply of parathyroid glands and their secretion of parathyroid hormone in hemodialysis patients with secondary hyperparathyroidism.

Saudi J Kidney Dis Transpl 2016 Mar;27(2):263-9

Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Characteristics of parathyroid glands usually determined by ultrasonography such as its total weight or volume might be a good indicator for the induction or suppression of parathyroid hormone (PTH) secretion from these glands. In the present study, we investigated the relationship between the volume and blood supply grade of the parathyroid glands, and its PTH secretion. Study subjects included 52 consecutive patients with the secondary hyperparathyroidism undergoing maintenance hemodialysis therapy referred to dialysis wards of the Imam Khomeini and Amiralam University Hospitals in Tehran. Serum intact PTH (i-PTH) was measured by an ELISA assay. The parathyroid glands characteristics were identified by ultrasonography that was performed simultaneously with blood collection. Parathyroid blood flows were evaluated by power-Doppler color imaging. There was no significant correlation between the total mass of the glands and serum concentration of i-PTH. No significant correlations were also observed between both total central and peripheral parathyroid glands blood flow and serum i-PTH level. Dialysis duration and serum alkaline phosphatase were significantly correlated in a positive manner with i-PTH level. Furthermore, serum level of i-PTH was not correlated with the total signals of glands blood flow in a multivariable linear regression analysis. Serum secreted i-PTH level might not be predictable by a total mass of parathyroid glands as well as their blood supply.
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http://dx.doi.org/10.4103/1319-2442.178257DOI Listing
March 2016

Coil Embolotherapy of Unilateral Diffuse Pulmonary Arteriovenous Malformations in a Nineteen-Year-Old Woman.

Iran J Radiol 2015 Jul 22;12(3):e9632. Epub 2015 Jul 22.

Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran.

Pulmonary arteriovenous malformations (AVMs) are rare vascular malformations of the lung that usually led to a notable risk of serious and life-threatening complications. There is considerable debate about the best management of strategies for the group of patients with diffuse AVMs. Several therapeutic options have been reported for management of this abnormality among which coil embolization is currently the preferred ones. This report describes our experience with the use of coiling method for treatment of multiple AVMs in an adult patient.
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http://dx.doi.org/10.5812/iranjradiol.9632DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623772PMC
July 2015

Renal Sympathetic Denervation by CT-scan-Guided Periarterial Ethanol Injection in Sheep.

Cardiovasc Intervent Radiol 2015 Aug 6;38(4):977-84. Epub 2015 May 6.

Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TMUS), Tehran, 1419733141, Iran,

Background: Renal nerves are a recent target in the treatment of hypertension. Renal sympathetic denervation (RSD) is currently performed using catheter-based radiofrequency ablation (RFA) and because this method has limitations, percutaneous magnetic resonance (MR)-guided periarterial ethanol injection is a suggested alternative. However, few studies have been conducted on the effectiveness of percutaneous ethanol injection for RSD.

Aim: To evaluate the feasibility, efficacy, and complications of computed tomography (CT)-guided periarterial ethanol injection.

Methods: Ethanol (10 ml, 99.6%) was injected around the right renal artery in six sheep under CT guidance with the left kidney serving as a control. Before and after the intervention, the sheep underwent MR imaging studies and the serum creatinine level was measured. One month after the intervention, the sheep were euthanized and norepinephrine (NE) concentration in the renal parenchyma was measured to evaluate the efficacy of the procedure. The treated tissues were also examined histopathologically to evaluate vascular, parenchymal, and neural injury.

Results: The right kidney parenchymal NE concentration decreased significantly compared with the left kidney after intervention (average reduction: 40%, P = 0.0016). Histologic examination revealed apparent denervation with no other vascular or parenchymal injuries observed in the histological and imaging studies.

Conclusion: Effective and feasible RSD was achieved using CT-guided periarterial ethanol injection. This technique may be a potential alternative to catheter-based RFA in the treatment of hypertension.
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http://dx.doi.org/10.1007/s00270-015-1109-0DOI Listing
August 2015

Peripheral venous malformations with a dominant outflow vein: results of ethanol embolization.

Acta Med Iran 2014 ;52(11):868-71

Department of Infectious Diseases, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Venous malformations are the most common form of symptomatic vascular malformations. VM s could classify into low-flow lesions (VMs) and high-flow lesions (AVMs). For low-flow venous lesions, direct percutaneous puncture with injection of sclerosing agents (sclerotherapy) has been described as a successful therapy. In this article, we want to introduce a patient who treated with ethanol sclerotherapy for VM located in the right flank. The patients were a 35-year-old man with right flank mass, skin discoloration and hemorrhagic foci. Color Doppler ultrasonography showed low flow vascular malformation while Magnetic Resonance Imaging (MRI) showed that the mass contained fat tissue with branching tubular signal void structures inside. The draining vein was first coiled via tortuous venous malformation vessels access and then VM was embolized.Under ultrasonographic guide, direct puncture of one branches of venous malformation was performed, and contrast media were injected. The patient underwent the sclerotherapy every month for four consecutive months. The patient was followed up for a year, and clinical examination revealed 40-50% size reduction of the lesion while no bleeding was detected from the lesion during the follow-up period. Sclerotherapy with ethanol is a useful method for embolizing VMs.
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July 2015

Contribution of stone size to chronic kidney disease in kidney stone formers.

Int J Urol 2015 Jan 28;22(1):104-8. Epub 2014 Aug 28.

Nephrology Research Center, Imam Khomeni Hospital, Tehran, Iran.

Objectives: To determine whether stone burden correlates with the degree of chronic kidney disease in kidney stone formers.

Methods: A total of 97 extracorporeal shockwave lithotripsy candidates aged 18 years and older were included. Size, number and location of the kidney stones, along with cumulative stone size, defined as the sum of diameters of all stones) were determined. Estimated glomerular filtration rate was determined using the Chronic Kidney Disease Epidemiology Collaboration cystatin C/creatinine equation, and chronic kidney disease was defined as estimated glomerular filtration rate <60 mL/min/1.73 m(2).

Results: In individuals with cumulative stone size <20 mm, estimated glomerular filtration rate significantly decreased when moving from the first (estimated glomerular filtration rate 75.5 ± 17.8 mL/min/1.73 m(2)) to the fourth (estimated glomerular filtration rate 56.4 ± 20.44 mL/min/1.73 m(2) ) quartile (P = 0.004). When patients with a cumulative stone size ≥ 20 mm were included, the observed association was rendered non-significant. In individuals with a cumulative stone size < 20 mm, each 1-mm increase in cumulative stone size was associated with a 20% increased risk of having chronic kidney disease. The relationship persisted even after adjustment for age, sex, body mass index, C-reactive protein, fasting plasma glucose, thyroid stimulating hormone, presence of microalbuminuria, history of renal calculi, history of extracorporeal shockwave lithotripsy, number and location of the stones (odds ratio 1.24, 95% confidence interval 1.02-1.52). The same was not observed for individuals with a cumulative stone size ≥ 20 mm.

Conclusions: In kidney stone formers with a cumulative stone size up to 20 mm, estimated glomerular filtration rate linearly declines with increasing cumulative stone size. Additionally, cumulative stone size is an independent predictor of chronic kidney disease in this group of patients.
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http://dx.doi.org/10.1111/iju.12606DOI Listing
January 2015

Establishing a liver transplantation program at Tehran University of Medical Sciences, Iran: a report of ten years of experience.

Arch Iran Med 2014 Jan;17(1):81-3

Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran.

In 2001, a Liver Transplantation (LT) program was commenced in Imam Khomeini Hospital Complex as the first one in the capital city of Tehran which is the second liver transplantation center in Iran. This study presents the results of our 10-year experience with LT.
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http://dx.doi.org/0141701/AIM.0012DOI Listing
January 2014

Intraosseous Lipoma of the Femor: Image Findings.

J Orthop Case Rep 2014 Jan-Mar;4(1):35-8

Radiologist, Atyeh Hospital, Farahzadi Blvd, Tehran, Iran.

Introduction: Intraosseous lipoma is a rare benign bone disease. Long and cancellous bones are the most locationsthat can be affected. Almost all lesions were discovered incidentally on imaging modalities that were done during an unrelated investigation. As it is rare, it may be mistaken for nonossifying fibroma, aneurismal bone cyst, simple bone cyst, bone infarct or chondroid tumors. Recently with the high quality imaging modalities such as CT scan and/or MR imaging, the diagnosis of intramedullary lipoma and some other bone lesions can be done without the need for bone biopsy and surgery.

Case Report: We're reporting a rare case of intraosseous lipoma of the distal femur. Plain film radiography showed barely visible medullary expansion and lucency in the distal left femoral diaphysis. The patient underwent further evaluation with computed tomographic (CT) and magnetic resonance Imaging (MRI). According to the MRI and CT scan findings, intraosseous lipoma was confirmed and the need for more diagnostic tests were eliminated.

Conclusion: Although Intraosseous lipoma doesn't have any manifestations clinically but it should be considered in the differential diagnosis of bone pains. MRI has an important role in characterization of soft tissue and bone marrow lesions therefore non-surgical approach for most of the patients with intraosseous lipoma would be beneficial.
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http://dx.doi.org/10.13107/jocr.2250-0685.146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4721877PMC
June 2016

Successful catheter-directed venous thrombolysis in an ankylosing spondylitis patient with phlegmasia cerulea dolens.

Iran J Radiol 2013 Jun 20;10(2):81-5. Epub 2013 May 20.

Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Ankylosing spondylitis (AS) is an inflammatory rheumatic disease. Phlegmasia cerulea dolens is a severe form of deep vein thrombosis characterized by swelling, pain, and bluish discoloration. Treatment delay may cause venous gangrene, tissue ischemia, limb loss or death. Here, we present an AS case who presented with phlegmasia cerulea dolens and treated by catheter-directed thrombolysis.
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http://dx.doi.org/10.5812/iranjradiol.11748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767019PMC
June 2013

Color Doppler indices of orbital arterial flow in end-stage renal disease patients; are the changes related to chronic hemodialysis or chronic renal failure?

Iran J Radiol 2012 Mar 25;9(1):12-6. Epub 2012 Mar 25.

Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

Background: Endothelial injury is a well-known complication in chronic kidney disease (CKD) and hemodialysis. One of the sites in which early vascular changes may be detected is the retina. Of course, these flow changes may not be detected in ophthalmologic exams, but it seems that color Doppler sonography of retinal arteries may be helpful in these cases.

Objectives: In previous studies on CKD patients who underwent chronic hemodialysis,hemodynamic changes were noted in retinal arteries, but no study has been performed to determine which of the two processes (CKD or chronic hemodialysis) can produce these changes. In this study, we tried to answer this question.

Patients And Methods: Doppler ultrasonography of the orbital vasculature including the ophthalmic artery and the central retinal artery was carried out in 17 patients (34 eyes) with chronic renal failure (CRF) who underwent hemodialysis, 17 patients (34 eyes)with CRF without a history of hemodialysis and 17 normal patients (34 eyes). The peak systolic velocity (PSV), end diastolic velocity (EDV) and resistance index were measured excluding hypertensive, diabetic patients and patients with cardiovascular disease.

Results: The mean PSV and EDV were lower only in the ophthalmic artery of CRF patients irrespective of the history of hemodialysis (PSV was 35.2 in hemodialysis, 38.8 in CRF and 51.6 in normal patients, P value = 0.001 and EDV was 7.4, 9.4, 11.8, respectively, P value =0.001) with no significant difference in the resistance index of the ophthalmic artery and other parameters [EDV, PSV, Resistance Index (RI)] in the central retinal artery.

Conclusions: The mean PSV and DSV in the ophthalmic artery were lower only in the ophthalmic artery of CRF patients regardless of the history of hemodialysis. No significant difference in the resistance index of the ophthalmic artery and other parameters (EDV, PSV) of the central retinal artery were noted between different groups. These findings suggest that microvascular disease and endothelial cell dysfunction of the orbital vasculature are related to CRF and not to chronic hemodialysis.
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http://dx.doi.org/10.5812/iranjradiol.6730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522344PMC
March 2012

Diffusion-weighted magnetic resonance imaging for diagnosis of liver fibrosis and inflammation in chronic viral hepatitis: the performance of low or high B values and small or large regions of interest.

Can Assoc Radiol J 2012 Nov 20;63(4):304-11. Epub 2012 Jan 20.

Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objective: To investigate the performance of different b values and regions of interest (ROI) for diagnosing liver fibrosis in patients with chronic viral hepatitis by using diffusion-weighted (DW) magnetic resonance imaging (MRI).

Methods: Eleven healthy participants and 33 patients with viral hepatitis B or C were enrolled. The stage of liver fibrosis and the grade of necroinflammation were determined by using a histologic activity index. Single-shot spin-echo echo-planar DW-MRI was performed in all participants at b values of 0-500, 0-700, and 0-1000 s/mm(2) by using 2 circular small and large ROIs of 100 and 200 mm(2). To evaluate the performance of different b values for determining cirrhosis, the receiver-operating characteristic curves were depicted, and the areas under the curves were compared.

Results: The average values of apparent diffusion coefficients significantly decreased with increasing stage or grade categories at all the 3 b values and for both small and large ROIs. The performance at b = 500 s/mm(2) was significantly better than b = 1000 s/mm(2) for determining cirrhosis or bridging fibrosis. The cut point of 153.4 for apparent diffusion coefficient (×10(-5) mm(2)/s) at b = 500 s/mm(2) could determine cirrhosis or bridging fibrosis with a sensitivity of 96% and specificity of 82%. No difference was found between the average apparent diffusion coefficient values of large or small ROIs. Also, there was no difference in performance of large or small ROIs in the diagnosis of liver fibrosis.

Conclusions: This study provided beneficial data for clinical utilisation of DW-MRI in diagnosing liver fibrosis: b = 500 s/mm(2) is better in performance than b = 1000 s/mm(2), and a small ROI of 100 mm(2) is sufficient for determining cirrhosis or bridging fibrosis.
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http://dx.doi.org/10.1016/j.carj.2011.04.002DOI Listing
November 2012

Antidepressant effects of magnetic resonance imaging--based stimulation on major depressive disorder: a double-blind randomized clinical trial.

Brain Imaging Behav 2012 Mar;6(1):70-6

Advanced Diagnostic and Interventional Radiology Research Center, Imaging Medical Center, Imam Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran.

Antidepressant effects of magnetic resonance imaging (MRI) based stimulation have been reported in animal studies, but no human studies are available on subjects with major depressive disorder. Here, the efficacy of two diagnostic MRI protocols (echo-planar diffusion-weighted imaging (DWI) and T1-weighted imaging) was assessed in patients with major depressive disorder. In this double-blind randomized clinical trial, 51 patients with clinically proven major depressive disorder were randomly enrolled into three equal groups. All patients were receiving a selective serotonin reuptake inhibitor as the only antidepressant treatment. The first group received echo-planar DW stimulation (DWI group), the second group received T1-weighted stimulation (T1 group), and the third group experienced a similar condition without receiving any magnetic stimulation (sham group). The Hamilton rating scale for depression (HAMD24) and Beck depression inventory (BDI) were used to assess the effect of MR stimulation on depressive symptoms. In comparison to baseline, mean HAMD24 and BDI scores significantly (p < 0.001) decreased in the DWI (by 35% and 39%) and T1 (by 38% and 39%) groups 2 weeks after MR stimulation. In the sham group, reduction in HAMD24 (19%, p = 0.04) and BDI score (15%, p = 0.07) were lower than the MR stimulation groups. Two weeks after the MR experiments, changes in mean HAMD24 score and BDI score were significantly (p < 0.05) higher in subjects treated with MR stimulation (DWI or T1) vs. sham group. In conclusion, this study demonstrated the antidepressant effects of DWI and T1 MRI protocols. Our results may point to usefulness of MR stimulation for clinical use in patients with major depressive disorder.
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http://dx.doi.org/10.1007/s11682-011-9143-2DOI Listing
March 2012

Transcatheter embolization of congenital hepatic arteriovenous malformation using ethylene-vinyl alcohol copolymer (Onyx).

Diagn Interv Radiol 2012 Mar-Apr;18(2):231-5. Epub 2011 Oct 14.

Department of Diagnostic and Interventional Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

A male infant with high-output heart failure who had been found to have a hepatic arteriovenous malformation by ultrasound imaging was referred to our center (Department of Diagnostic and Interventional Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Islamic Republic of Iran) for further evaluation. Computed tomography angiography revealed a large hepatic arteriovenous malformation with feeders originating from enlarged hepatic arteries and draining to enlarged hepatic veins. We performed a transcatheter embolization of the anomaly using ethylene vinyl alcohol copolymer (Onyx) during a single session. The cardiac function of the infant rapidly improved after the procedure. Over the 19 months of follow-up, his cardiac output remained stable and within the normal limits, and no complications were detected.
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http://dx.doi.org/10.4261/1305-3825.DIR.4418-11.0DOI Listing
July 2012

Improvement of MR cholangiopancreatography (MRCP) images after black tea consumption.

Eur Radiol 2011 Dec 5;21(12):2551-7. Epub 2011 Aug 5.

Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objective: Evaluation of the efficacy of black tea as the negative oral contrast agent in MRCP.

Materials And Methods: MRCP was performed before and 5 and 15 min after tea consumption for 35 patients. Depiction of the gall bladder (GB), cystic duct (CD), proximal and distal parts of the common bile duct (CBD), intrahepatic ducts (IHD), ampulla of vater (AV), main pancreatic duct (MPD) and signal loss of stomach and three different segments of the duodenum were investigated according to VAS and Likert scores.

Results: Twenty-one of the patients (60%) were female (mean age, 50.3  ±  19.2 years). Regarding visibility of different anatomical parts of the pancreatobiliary tree, the post procedure images were better visualized in the distal part of CBD, AV and MPD in Likert and VAS scoring (all P  ≤  0.001). Regarding obliteration of high signal in the stomach and three different parts of the duodenum, all post procedure images showed significant disappearance of high signal in Likert and VAS scoring systems (all Ps ≤ 0.001).

Conclusion: Black tea is a simple and safe negative oral contrast agent which reduces the signal intensity of gastrointestinal tract fluid and provides improved depiction of the MPD, the distal CBD and the ampulla during MRCP. Key Points •Tea is an effective negative oral contrast agent for gastrointestinal MRI •Ingestion of black tea improves conspicuity of the distal CBD in MRCP.
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http://dx.doi.org/10.1007/s00330-011-2217-0DOI Listing
December 2011

A review on dural tail sign.

World J Radiol 2010 May;2(5):188-92

Houman Sotoudeh, Department of Radiology, Vali Asr Hospital, Arak University of Medical Sciences, Vali Asr Sq, 38137, Arak, Iran.

"Dural tail sign" (DTS) which is a thickening of the dura adjacent to an intracranial pathology on contrast-enhanced T1 MR Images, was first thought to be pathognomonic of meningioma, however, many subsequent studies demonstrated this sign adjacent to various intra- and extra-cranial pathologies and in spinal lesions. In this paper we outline the history, accompanying pathologies and the differentiation and probable pathophysiology of DTS. We also discuss whether we can predict tumoral involvement of the dural tail before surgery and whether the dural tail adjacent to a tumor should be resected.
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http://dx.doi.org/10.4329/wjr.v2.i5.188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999017PMC
May 2010

Metastatic renal cell carcinoma initially presented with an intramedullary spinal cord lesion: a case report.

Cases J 2009 Sep 11;2:7805. Epub 2009 Sep 11.

Department of General Internal Medicine, Imam Khomeini Hospital, Keshavarz Boulevard, Medical Sciences/Tehran University,Tehran, Iran.

Introduction: One of the rare manifestations of systemic neoplasia is intramedullary spinal cord metastasis that causes serious diagnostic and therapeutic dilemma. It has been very rarely reported as the initial manifestation of carcinoma. This is report of a metastatic renal cell carcinoma initially presented with intramedullary spinal cord lesion, to our knowledge there are few similar reports in literature.

Case Presentation: We report a 51-year-old Iranian woman who presented with back pain and paraparesis. MR imaging study of her spine showed an enhancing cystic lesion at the level of conus medullaris. Despite detailed investigation, no specific aetiology was found till a bone scan obtained to evaluate an agonizing pain on the dorsum of the left hand revealed photon deficient area within the left kidney in addition to oseoblastic bony lesions. After thorough imaging investigation she underwent radical nephrectomy which confirmed renal cell carcinoma.

Conclusion: Considering the prevalence of cancer, it is imperative that clinicians be mindful of occult carcinoma as the cause of suspicious intramedullary spinal cord lesion.
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http://dx.doi.org/10.4076/1757-1626-2-7805DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769375PMC
September 2009

Predictive plain X-ray findings in distinguishing early stage acute lymphoblastic leukemia from juvenile idiopathic arthritis.

Clin Rheumatol 2009 Nov 21;28(11):1253-8. Epub 2009 Jul 21.

Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Acute lymphoblastic leukemia (ALL) presenting with musculoskeletal pain may be difficult to distinguish from juvenile idiopathic arthritis (JIA). The objective of this study, which separates it from most studies investigating these two diseases, is to determine the role of plain radiography in the initial approach toward patients presenting with musculoskeletal symptoms and to look for signs suggestive of each of the two disease entities. X-rays of patients referred to our center for musculoskeletal symptoms and ultimately diagnosed with JIA or ALL over a period of 10 years were studied retrospectively. The X-rays had been performed in the preliminary stage of the disease process and before the initiation of specific therapeutic measures. Soft tissue swelling, osteopenia, radiolucent metaphyseal bands, coarse trabeculation, and periosteal reactions were studied, and data analysis was performed by SPSS. Among a total of 174 patients, 118 had been diagnosed with JIA and 56 with ALL. The average age of JIA patients and ALL patients were 7.5 and 7.2 years, respectively. Soft tissue swelling was significantly more common among JIA patients (89.8%) than among those with ALL (1.8%) (P < 0.0001). Therefore, it is of the utmost importance to note the presence or absence of soft tissue swelling on plain radiography in the initial diagnostic approach. Osteopenia was seen in 60.2% of JIA patients compared with 14.3% of ALL patients (P < 0.0001). Radiolucent metaphyseal bands were seen among 7.1% of ALL cases but were notably absent in all cases of JIA. Coarse trabeculation was significantly higher in patients with ALL (7.1% ) than among JIA patients (0.8%). Periosteal reactions were seen in 6.8% of JIA group compared with 1.8% of ALL patients. We concluded that plain X-ray may be useful in selecting patients requiring bone marrow examination among those presenting with musculoskeletal symptoms mimicking JIA.
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http://dx.doi.org/10.1007/s10067-009-1221-0DOI Listing
November 2009

Endovascular treatment of renal arteriovenous fistula following a stab wound.

Urol J 2008 ;5(2):129-31

Department of Radiology and Imaging, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

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August 2008

Pathologic significance of the "dural tail sign".

Eur J Radiol 2009 Apr 21;70(1):10-6. Epub 2008 Feb 21.

Department of Radiology and Imaging, Imam Khomeini Hospital, Keshavarz Boulevard, Medical Sciences/Tehran University, Tehran, Iran.

Objective: The exact nature of the "dural tail sign" (thickening of the dura adjacent to the tumour in contrast enhanced T1-MRI imaging) is still not clearly established. In this study we tried to verify the histological appearance of the "dural tail sign" and probable correlation between different MRI findings and dural tail histology.

Material And Methods: In this study, 129 patients with intracranial lesions underwent MRI imaging with 1.5T scanner. The "dural tail sign" was defined using Goldsher et al. criteria. Size and pattern of enhancement of the tumour and adjacent dura was noted in MRI and in the pathologic samples, dural tail and the dura beneath the tumour was assessed.

Results: In 30 cases, "dural tail sign" was evident on MRI, dural tail noted in 17 of these cases in histological samples (12 meningiomas, 3 pituitary adenomas and 2 schwannomas). All of them had vessel dilatation, 6 showed tumoural invasion, 4 demonstrated intravascular growth of the lesion and 1 showed inflammation of the dura.

Conclusion: In our study MRI findings failed to predict tumoural invasion of the dural tail in histologic samples and because of frequent presence of tumour nests in it, the dura matter should be resected as widely as possible.
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http://dx.doi.org/10.1016/j.ejrad.2008.01.010DOI Listing
April 2009

Antidepressant-like effect of magnetic resonance imaging-based stimulation in mice.

Prog Neuropsychopharmacol Biol Psychiatry 2007 Mar 10;31(2):503-9. Epub 2007 Jan 10.

Department of Radiology and Imaging, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Keshavarz Blvd., Tehran 14197-33141, Iran.

Introduction: It has been reported that a novel type of magnetic resonance imaging (MRI) scan called echo planar magnetic resonance spectroscopic imaging (EP-MRSI) may show antidepressant effects. We examined whether the two routine diagnostic protocols of MRI [T1 and echo planar diffusion weighted imaging (EPI-DWI)], have antidepressant-like effects in an animal model of depression.

Methods: The effects of standard EPI-DWI and T1 MRI on immobility, swimming and climbing times in the modified forced swimming test (FST) in mice were examined. After exposure to the first session of modified forced swimming test, we randomly divided the mice into four groups. The first group (T1 MRI group, n=21) received a 15-minute stimulation of T1 sequence. The second group (EPI-DWI MRI group, n=21) received a 15-minute stimulation of EPI-DWI protocol. The third group (sham group, n=21) spent 15 min in a tunnel similar to the MRI gantry in terms of size, temperature and light intensity and received recorded sounds from a normal session of EPI-DWI with similar duration and intensity. The fourth group acted as controls (n=21). The second session of the modified FST was conducted twelve hours later. The mean of immobility, swimming and climbing times in this session were compared to the control group.

Results: T1 weighted and EPI-DWI MRI groups showed a reduction in immobility time compared to the control group (P value<0.002, P value<0.017 respectively). This effect is comparable to that seen in the FST after the administration of antidepressant agents. The climbing time in the group subjected to EPI-DWI MRI was longer than the control group (P value<0.035). Previous studies showed similar effects after the administration of antidepressant drugs affecting the catecholamine systems. The swimming time in the T1 MRI group was significantly longer than the control group (P value<0.037). Previous studies showed qualitatively similar effect to that of anti-depressant drugs affecting the serotoninergic systems. The swimming, climbing and immobility times in the sham and control groups showed no significant difference.

Conclusions: Our findings raise the possibility that MRI-based stimulation may have antidepressant-like effects in mice. This is likely to be through different mechanisms in T1 weighted and EPI-DWI protocols. However the possible biological basis of this effect is not yet understood and we would advocate further studies of MRI-based stimulation effects on transmitters in the different organs in the body specially the brain.
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http://dx.doi.org/10.1016/j.pnpbp.2006.11.021DOI Listing
March 2007

Prevalence of "dural tail sign" in patients with different intracranial pathologies.

Eur J Radiol 2006 Oct 3;60(1):42-5. Epub 2006 May 3.

Department of Radiology and Imaging, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran.

The purpose of this study is to clarify the prevalence, spectrum of associated tumors and the diagnostic value of the linear meningeal thickening and enhancement adjacent to a peripherally located cranial mass "dural tail sign"(DTS) in contrast enhanced magnetic resonance imaging (MRI). In this prospective descriptive cross-sectional study conducted from 2002 to 2005, 110 patients with imaging-proven intracranial lesions and no history of previous intracranial surgery were referred to the neurosurgery clinic of our hospital for surgical resection. All underwent imaging with a 1.5 T MR system with and without contrast injection. Twelve patients were excluded from our study and finally 98 patients were evaluated for the presence of "dural tail sign". Twenty-two of 98 patients (22.44%) with intracranial masses exhibited the "dural tail sign" (18 meningiomas, 2 pituitary adenomas, 1 primary cerebral lymphoma and 1 fungal brain abscess). Fifty-eight percent of the patients with biopsy-proven meningioma were observed to show "dural tail sign". In conclusion, we found the "dural tail sign" to have a sensitivity of 58.6% and specificity of 94.02% in diagnosis of meningioma.
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http://dx.doi.org/10.1016/j.ejrad.2006.04.003DOI Listing
October 2006
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