Publications by authors named "Soheil Kooraki"

25 Publications

  • Page 1 of 1

Image-Guided Biopsies and Interventions of Mediastinal Lesions.

Radiol Clin North Am 2021 Mar 9;59(2):291-303. Epub 2021 Jan 9.

Thoracic and Interventional Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1621, Los Angeles, CA 90095, USA. Electronic address:

Optimal assessment of the mediastinal masses is performed by a combination of clinical, radiological and often histological assessments. Image-guided transthoracic biopsy of mediastinal lesions is a minimally invasive and reliable procedure to obtain tissue samples, establish a diagnosis and provide a treatment plan. Biopsy can be performed under Computed Tomography, MRI, or ultrasound guidance, using a fine needle aspiration or a core-needle. In this paper, we review the image-guided strategies and techniques for histologic sampling of mediastinal lesions, along with the related clinical scenarios and possible procedural complications. In addition, image-guided mediastinal drainage and mediastinal ablations will be briefly discussed.
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http://dx.doi.org/10.1016/j.rcl.2020.11.009DOI Listing
March 2021

Evaluation of cross-sectional imaging features that aid in the differentiation of benign and malignant splenic lesions.

Eur J Radiol 2021 Mar 13;136:109549. Epub 2021 Jan 13.

Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.

Purpose: This study aimed to investigate the role of cross-sectional imaging in differentiating between benign and malignant splenic lesions based on various imaging features.

Methods: Database of imaging reports from January 2015 to December 2017 were searched dedicatedly for "spleen" or "splenic" terms to identify patients with splenic lesions found either on CT or MRI. The study cohort consisted of patients who had available histological reports or had follow-up imaging for a minimum of one year. Patients were categorized into the benign subcohort if they did not have a history of extra-splenic malignancy, and had a splenic lesion(s) falling into one of these categories: benign histopathology on biopsy, stable size and enhancement, or decreased size on follow-up imaging. Those who had malignant histopathology on biopsy were included in the malignant subcohort. Various morphologic features and enhancement patterns of these lesions were carefully reviewed by two radiologists who were blinded to the final histopathologic diagnosis.

Results: We identified 161 patients (54 % males, mean age ± SD = 59.7 ± 15.4) including 124 (77 %) in the benign and 37 (23 %) in the malignant subcohort. Benign lesions were more likely to be cystic (21.7 % vs 2.7 %, p < 0.001), homogenous (59.7 % vs. 29.7 %, p = 0.001) and to demonstrate well-defined borders (69.3 % vs. 29.7 % p= <0.001). Malignant lesions had significantly larger diameter (median size: 15 vs 11 mm, p = 0.03). Restricted diffusion was not seen in any of the benign lesions; however, 50 % of malignant lesions demonstrated restricted diffusion (p = 0.003). Features such as lesion distribution, presence of calcification, splenomegaly and number of lesions were not significantly different between benign and malignant lesions.

Conclusion: Smaller lesion diameter, well-defined border and homogeneity favor benign nature of splenic lesions while restricted diffusion should raise suspicion for malignancy.
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http://dx.doi.org/10.1016/j.ejrad.2021.109549DOI Listing
March 2021

Posterior Reversible Encephalopathy Syndrome after Allogeneic Stem Cell Transplantation in Pediatric Patients with Fanconi Anemia, a Prospective Study.

Biol Blood Marrow Transplant 2020 12 27;26(12):e316-e321. Epub 2020 Aug 27.

Pediatric Cell Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Posterior reversible encephalopathy syndrome (PRES) is one of the most common neurologic complications following hematopoietic stem cell transplantation (HSCT). We aimed to evaluate the incidence, clinical, and imaging features of PRES in pediatric patients with Fanconi anemia (FA) following HSCT. This prospective study included all post-HSCT patients with underlying FA disease between 2014 and 2017. Brain computed tomography scan and magnetic resonance imaging (MRI) were performed in all individuals who developed neurologic symptoms. PRES was diagnosed based on clinic-radiological evidence. Follow-up MRI was performed in all patients with PRES within two months. Forty-one patients with FA (28 males; mean age, 8.19 ± 3.25 years) were enrolled. Out of 15 patients with acute neurologic symptoms, PRES was diagnosed in 9 individuals (21.95% of the total cohort). The occurrence of PRES was significantly higher in patients who had a donor with a 1-locus mismatch (P= .02). Donor relation, stem cell source, and graft-versus-host disease grade did not have any significant association with the development of PRES. MRI showed asymmetric vasogenic edema in 5 patients, an overt infarct in 1 patient, and foci of microhemorrhages in 3 patients, 1 of whom developed a hemorrhagic infarct. This patient died shortly, and persistent microhemorrhages were noted in the other 2 patients. Our findings demonstrate a greater risk of developing PRES after HSCT in patients with FA compared with those with other diseases (21.95% versus 1% to 10%), and in contrast to its term, it might be irreversible and has adverse effects on HSCT outcomes. The increased vascular and endothelial fragility in FA may contribute to the higher frequency of PRES in these individuals.
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http://dx.doi.org/10.1016/j.bbmt.2020.08.021DOI Listing
December 2020

Potential MR Enterography Features to Differentiate Primary Small Intestinal Lymphoma From Crohn Disease.

AJR Am J Roentgenol 2020 10 22;215(4):864-873. Epub 2020 Jul 22.

Department of Surgical and Medical Sciences and Translational Medicine, School of Medicine and Psychology, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy.

The purpose of this study was to assess the MR enterographic features of primary small intestinal lymphoma (PSIL) and compare them with active Crohn disease (CD) presenting with severe (≥ 10 mm) mural thickening of the small bowel. This retrospective study included 15 patients with pathologically proven PSIL and 15 patients with active inflammatory CD with severe mural thickening. Various morphologic, enhancement, and diffusion parameters were compared between the two groups at MR enterography. The ratios of the upstream to involved luminal diameter and mural thickness to luminal diameter in the involved segment were calculated. An attempt was made to define a predictive model (morphologic score) for discriminating PSIL from CD with severe mural thickening. Patients with PSIL were more likely than those with CD to have unifocal disease (66.7% vs 20.0%, = 0.025), circumferential involvement (86.7% vs 26.7%, < 0.001), luminal dilatation (60.0% vs 7.0%, = 0.005), and an attenuated fold pattern (53.3% vs none, < 0.001). They were less likely to have serosal surface involvement (40.0% vs 100%, = 0.001) and mesenteric fat infiltration (33.3% vs 100%, < 0.001). Median upstream to involved luminal diameter ratio (1.5 vs 9.6, < 0.001) and mural thickness to involved luminal diameter ratio (1.1 vs 4.3, = 0.044) were significantly lower in patients with PSIL than in those with CD with severe mural thickening. No significant difference was observed in enhancement and diffusion measures. Morphologic score was based on the presence of luminal dilatation, unifocal involvement, mesenteric fat infiltration, and luminal stricture, yielding accuracy of 98% for differentiation between PSIL and CD with severe mural thickening. Morphologic features seen at MR enterography rather than enhancement or diffusion parameters may be valuable for differentiation of PSIL from active CD with severe mural thickening with significantly lower ratios of upstream to involved luminal diameter and mural thickness to involved luminal diameter in PSIL.
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http://dx.doi.org/10.2214/AJR.19.22158DOI Listing
October 2020

Coronavirus Disease 2019 (COVID-19) Precautions: What the MRI Suite Should Know.

J Am Coll Radiol 2020 07 21;17(7):830. Epub 2020 May 21.

Keck School of Medicine, University of Southern California, Division of Emergency Radiology, Department of Radiology, 1500 San Pablo Street, Los Angeles, CA 90033. Electronic address:

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http://dx.doi.org/10.1016/j.jacr.2020.05.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7241370PMC
July 2020

Re: Ventilation-Perfusion Scans During the Coronavirus Disease 2019 (COVID-19) Outbreak.

J Am Coll Radiol 2020 06 10;17(6):698-699. Epub 2020 Apr 10.

Keck School of Medicine, University of Sothern California (USC), 1500 San Pablo Street, Los Angeles, CA 90033. Electronic address:

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http://dx.doi.org/10.1016/j.jacr.2020.03.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146688PMC
June 2020

Radiologic Findings of Coronavirus Disease (COVID-19): Clinical Correlation Is Recommended.

AJR Am J Roentgenol 2020 07 16;215(1):W7. Epub 2020 Apr 16.

University of Southern California, Los Angeles, CA

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http://dx.doi.org/10.2214/AJR.20.23211DOI Listing
July 2020

Radiology Perspective of Coronavirus Disease 2019 (COVID-19): Lessons From Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome.

AJR Am J Roentgenol 2020 05 28;214(5):1078-1082. Epub 2020 Feb 28.

Department of Radiological Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Since the outbreak of the novel coronavirus pulmonary illness coronavirus disease 2019 (COVID-19) in China, more than 79,000 people have contracted the virus worldwide. The virus is rapidly spreading with human-to-human transmission despite imposed precautions. Because similar pulmonary syndromes have been reported from other strains of the coronavirus family, our aim is to review the lessons from imaging studies obtained during severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) outbreaks. The review of experiences with the MERS and SARS outbreaks will help us better understand the role of the radiologist in combating the outbreak of COVID-19. The known imaging manifestations of the novel coronavirus and the possible unknowns will also be discussed.
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http://dx.doi.org/10.2214/AJR.20.22969DOI Listing
May 2020

Coronavirus (COVID-19) Outbreak: What the Department of Radiology Should Know.

J Am Coll Radiol 2020 04 19;17(4):447-451. Epub 2020 Feb 19.

Division of Emergency Radiology, Department of Radiology, Keck School of Medicine, University of Sothern California, Los Angeles, California. Electronic address:

In December 2019, a novel coronavirus (COVID-19) pneumonia emerged in Wuhan, China. Since then, this highly contagious COVID-19 has been spreading worldwide, with a rapid rise in the number of deaths. Novel COVID-19-infected pneumonia (NCIP) is characterized by fever, fatigue, dry cough, and dyspnea. A variety of chest imaging features have been reported, similar to those found in other types of coronavirus syndromes. The purpose of the present review is to briefly discuss the known epidemiology and the imaging findings of coronavirus syndromes, with a focus on the reported imaging findings of NCIP. Moreover, the authors review precautions and safety measures for radiology department personnel to manage patients with known or suspected NCIP. Implementation of a robust plan in the radiology department is required to prevent further transmission of the virus to patients and department staff members.
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http://dx.doi.org/10.1016/j.jacr.2020.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102595PMC
April 2020

Differentiation between benign and malignant thyroid nodules using diffusion-weighted imaging, a 3-T MRI study.

Indian J Radiol Imaging 2018 Oct-Dec;28(4):460-464

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

Background: Preoperative differentiation of benign from malignant thyroid nodules remains a challenge. Aims: This study assessed the accuracy of diffusion-weighted imaging (DWI) for differentiation between benign and malignant thyroid nodules.

Materials And Methods: Preoperative DWI was performed in patients with thyroid nodule by means of a 3-T scanner magnetic resonance imaging (MRI). Images were obtained at b value of 50, 500, and 1000 mm/s to draw an ADC (apparent diffusion coefficient) map. Findings were compared with postoperative histopathologic results. Receiver operating characteristic curve was used to assess the accuracy of different cutoff points.

Results: Forty-one thyroid nodules (26 benign and 15 malignant) were included in this study. None of static MRI parameters such as signal intensity, heterogeneity, and nodule border was useful to discriminate between benign and malignant lesions. Mean ADC value was (1.94 ± 0.54) × 10 mm/s and (0.89 ± 0.29) × 10 mm/s in benign and malignant nodules, respectively (-value < 0.005). ADC value cutoff of 1 × 10 mm/s yielded an accuracy, sensitivity, and specificity of 93%, 87%, and 96% to discriminate benign and malignant nodules.

Conclusion: DWI is highly accurate for discrimination between benign and malignant thyroid nodules.
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http://dx.doi.org/10.4103/ijri.IJRI_488_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319093PMC
January 2019

3T magnetic resonance spectroscopy as a powerful diagnostic modality for assessment of thyroid nodules.

Arch Endocrinol Metab 2018 Oct;62(5):501-505

The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran.

Objective: Magnetic resonance spectroscopy (MRS) is a powerful tool for structural studies of chemical compounds and biomolecules and also documented promising findings as a potential imaging technology in thyroid oncology. This prospective study was to ascertain the clinical significance of 3 Tesla MRS in the evaluation of patients with thyroid nodules (TNs) as an ancillary diagnostic technique for thyroid carcinoma.

Materials And Methods: Magnetic resonance spectroscopy at 3T at echo- times (TEs) 136 and 270 ms was carried out on 15 patients with total number of 32 TNs larger than 1 cm3, which all were surgically resected. Choline (Chol) to creatine (Cr) ratio was assessed at 136 and 270 TEs on each nodule and a receiver operating characteristic (ROC) curve was used to determine optimal cut-off point. The findings were compared with histopathology of thyroid specimens.

Results: There were 23 benign and 9 malignant lesions (7 papillary and 2 follicular thyroid carcinomas). The mean values of Chol/Cr at 136 and 270 TEs was 2.28 ± 3.65 and 1.52 ± 1.67 respectively and the difference between benign and malignant nodules was only significant at 136 TEs. The study revealed that Chol/ Cr ratio cut-off point of 2.5 best correlates with histopathology results (sensitivity = 75%; specificity = 100%; PPV = 100%; NPV= 92%).

Conclusion: This preliminary study showed that 3T magnetic resonance spectroscopy might be a specific modality for the evaluation of thyroid nodules in differentiation of benign from malignant thyroid tissue. However, a larger series would give much greater confidence that this state-of-the-art technology will worth pursuing in clinical practice.
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http://dx.doi.org/10.20945/2359-3997000000069DOI Listing
October 2018

Hot Topics of Research in Musculoskeletal Imaging: PET/MR Imaging, MR Fingerprinting, Dual-energy CT Scan, Ultrashort Echo Time.

PET Clin 2019 Jan 24;14(1):175-182. Epub 2018 Oct 24.

Department of Diagnostic Radiology, Keck School of Medicine, University of Southern California (USC), 1520 San Pablo Street, Suite L1600, Los Angeles, CA 90033, USA. Electronic address:

We aimed to review the latest cutting-edge trends in emerging techniques of musculoskeletal imaging. This study reviews the current status and the preliminary studies of Magnetic Resonance Fingerprinting (MRF), Ultrashort Echo Time (UTE) sequence, Positron Emission Tomography (PET)/MR and Dual-Energy CT scan (DECT) in various oncologic and non-oncologic conditions of the musculoskeletal system. The current application, current and future research trends and limitations of each imaging technique were discussed. There are substantial potentials in MRF, UTE, PET/MR and DECT for characterization of various musculoskeletal disorders. Further dedicated studies in various fields are necessary.
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http://dx.doi.org/10.1016/j.cpet.2018.08.014DOI Listing
January 2019

Prevalence and Clinical Outcomes of Common Bile Duct Dilation in Patients Who Use Opium.

Am J Med Sci 2018 07 7;356(1):39-46. Epub 2018 Apr 7.

Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: This study aimed to evaluate the association of various opium-related factors with common bile duct (CBD) diameter in individuals who use opium in the general population and investigate the clinical importance and long-term outcomes.

Materials And Methods: In this prospective study, 2,400 participants were randomly selected from the Golestan Cohort study. Opium consumption data were recorded. CBD diameter was measured by ultrasound. Transient elastography was performed at enrollment and 3 years later. Participants were followed up for at least 5 years.

Results: A total of 1,599 individuals, aged above 50 years, were enrolled and 167 subjects were users of opium. CBD diameter was significantly higher in users of opium than controls (mean ± standard deviation:5.54 ± 1.95 versus 4.74 ± 1.34mm, P < 0.001). This difference was noted with all opium types, but mostly by users of heroin (P < 0.001). Ingestion of opium caused greater CBD dilatation than inhalation (coefficient: 1.16; 95% CI: 0.05-2.27, P = 0.04 versus coefficient: 0.98; 95% CI: 0.75-1.20, P < 0.001). Transient elastography results did not show any association between fibroscan score change and CBD diameter. No major related malignancy was seen during follow-up.

Conclusions: This study strengthened the evidence of an association of opium use with increased CBD diameter in a population-based setting without significantly increased risk of pancreaticobiliary malignancies or liver fibrosis. We cautiously suggest that opium-induced CBD dilatation may not require further diagnostic work-up.
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http://dx.doi.org/10.1016/j.amjms.2018.04.003DOI Listing
July 2018

MR enterography in nonresponsive adult celiac disease: Correlation with endoscopic, pathologic, serologic, and genetic features.

J Magn Reson Imaging 2017 10 9;46(4):1096-1106. Epub 2017 Feb 9.

Autoimmune and Motility Disorders of the Gastro-Intestinal Tract Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To assess small bowel abnormalities on magnetic resonance enterography (MRE) in adult patients with nonresponsive celiac disease (CD) and investigate their associations with endoscopic, histopathologic, serologic, and genetic features.

Materials And Methods: This prospective study was carried out between September 2012 and August 2013. After approval by the Ethics Committee of our institution, informed consent was acquired from all participants. Forty consecutive patients with nonresponsive CD, aged 17-76 years, underwent MRE using a 1.5T unit. Sequences included T -HASTE, True-FISP, pre- and postcontrast VIBE to assess the quantitative (number of ileal and jejunal folds) and qualitative (fold pattern abnormalities, mural thickening, increased enhancement, bowel dilatation, or intussusception) measures. Endoscopic manifestations were categorized as normal/mild vs. severe. Histopathological results were divided into mild and severe. Genotyping of HLA-DQ2 and DQ8 was performed. Serum levels of tissue-transglutaminase, endomysial, and gliadin antibodies were also determined. Logistic regression analysis and receiver operating characteristic (ROC) curve were used.

Results: Twenty-nine (72.5%) cases showed abnormal MRE. Reversed jejunoileal fold pattern had significant association with severe endoscopic (odds ratio [OR] = 8.38, 95% confidence interval [CI] 1.73-40.5) and pathologic features (OR = 7.36, 95% CI 1.33-40.54). An increased number of ileal folds/inch was significantly associated with severe MARSH score and positive HLA-DQ8. (P < 0.001 and P = 0.026, respectively). Ileal fold number had the highest areas under the curve for prediction of severe endoscopic (AUC: 0.75, P = 0.009) and pathologic (AUC: 0.84, P < 0.001) findings and positive anti-transglutaminase antibody (AUC: 0.85, P = 0.027).

Conclusion: Fold pattern reversal on MRE is highly associated with endoscopic and pathologic features of refractory celiac disease (RCD). Increased ileal folds showed higher correlation with endoscopic-pathologic features, HLA-DQ8, and anti-transglutaminase level. MRE might be more sensitive for detection of increased ileal folds in CD rather than reduction of duodenal and jejunal folds due to better distension of ileal loops.

Level Of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1096-1106.
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http://dx.doi.org/10.1002/jmri.25646DOI Listing
October 2017

Assessment of Abdominal Fat Distribution in Non-Alcoholic Fatty Liver Disease by Magnetic Resonance Imaging: a Population-based Study.

Arch Iran Med 2016 Oct;19(10):693-699

Professor of Medicine, Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran 14117-13135, Iran.

Background: To investigate the association between non-alcoholic fatty liver disease (NAFLD) and quantitative measures of central adiposity in the general population using a semi-automated method on magnetic resonance imaging (MRI) data.

Methods: Subjects were recruited from Golestan Cohort Study. Two groups of 120 individuals with and without fatty liver were randomly selected based on findings of ultrasound. Non-invasive diagnosis of NAFLD was made by combination of ultrasound and MRI. Various anthropometric indices including body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were measured. Segmentation and calculation of visceral (VFA) and subcutaneous fat area (SFA) were performed on three levels of MRI slices using semi-automated software.

Results: A total of 109 individuals fulfilled the NAFLD criteria, while 92 subjects were selected as the control group. All obesity measures, except for SFA, were significantly higher in subjects with NAFLD compared to controls. Significant associations were found between NAFLD and adiposity indices, except for SFA, with the highest odds ratio observed in WHR (OR: 3.37, CI: 1.40-3.70, P < 0.001). VFA also had the greatest correlation with ultrasound (r = 0.523, P < 0.001) and MRI (r = 0.546, P < 0.001) indicators of NAFLD.

Conclusions: Quantitative measures of visceral adiposity are associated with NAFLD, while subcutaneous fat measures are poor indicators for identifying NAFLD. Compared to conventional anthropometric indices, VFA best correlates with ultrasound and MRI criteria of fatty liver.
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http://dx.doi.org/0161910/AIM.005DOI Listing
October 2016

Pretreatment Evaluation of Glioma.

Neuroimaging Clin N Am 2016 Nov 3;26(4):567-580. Epub 2016 Sep 3.

Division of Neuroradiology, Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Glioma is considered the most common type of primary central nervous system (CNS) tumor. Imaging is crucial for diagnosis, characterization, grading, and therapeutic planning of CNS gliomas. Along with a brief description of conventional computed tomography and magnetic resonance imaging techniques, this article reviews the ever-developing role of modern imaging techniques in preoperative management of CNS gliomas. It discusses current clinical applications, promising features, and limitations of each imaging method.
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http://dx.doi.org/10.1016/j.nic.2016.06.006DOI Listing
November 2016

Gallstone disease and obesity: a population-based study on abdominal fat distribution and gender differences.

Ann Hepatol 2015 Sep-Oct;14(5):702-9

Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences. Tehran, Iran.

Background: Existing evidence suggests the visceral fat is more metabolically active than subcutaneous fat. We aimed to investigate the value of subcutaneous (SAT) and visceral adipose tissue thickness (VAT) for prediction of gallstone disease (GSD) in general population by focus on gender differences and comparison with body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR).

Material And Methods: In this cross-sectional survey, 1,494 subjects (51.4 % men), aged above 50, randomly selected from Golestan Cohort Study residing in Gonbad City, Iran, underwent anthropometric measurements and abdominal ultrasonography.

Results: Prevalence of GSD was 17.8% (95% CI 15.9-19.8). Following adjustment for age and then other potential risk factors, all obesity indices, except for SAT, were associated with GSD in women with the highest odds ratio observed in WHtR (OR 1.52, 95% CI 1.22-1.89). In contrast, WHR was the only associated index in men (OR 1.49, 95% CI 1.08-2.06). The trend of increasing obesity measures across the quartiles with the risk of GSD was significant in subgroups of WHtR and BMI in women and WHR in men. No significant association was found between SAT and GSD in men or women.

Conclusions: The best anthropometric indicators of the risk of GSD may differ by gender. In men, WHR might be the only preferred index to estimate risk of GSD. WHtR, WHR, VAT and BMI are associated with GSD risk in women, although WHtR might better explain this risk. SAT is the poor indicator for identifying subjects with GSD in both genders.
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May 2016

Covered stents for exclusion of iatrogenic common carotid artery-internal jugular vein fistula and brachiocephalic artery pseudoaneurysm.

J Neurointerv Surg 2016 Aug 29;8(8):e31. Epub 2015 Jun 29.

Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany.

Covered stents have rarely been used in neuroendovascular procedures. We report the case of a 74-year-old woman with a complex iatrogenic vascular injury from attempted insertion of a hemodialysis catheter: concurrent brachiocephalic artery pseudoaneurysm and common carotid artery to internal jugular vein fistula. Both lesions were excluded successfully by using two balloon-expandable covered stents with a satisfactory short-term clinical and angiographic outcome.
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http://dx.doi.org/10.1136/neurintsurg-2015-011760.repDOI Listing
August 2016

Covered stents for exclusion of iatrogenic common carotid artery-internal jugular vein fistula and brachiocephalic artery pseudoaneurysm.

BMJ Case Rep 2015 Jun 23;2015. Epub 2015 Jun 23.

Department of Neuroradiology, University Hospital Freiburg, Freiburg im Breisgau, Baden-Wurttemberg, Germany.

Covered stents have rarely been used in neuroendovascular procedures. We report the case of a 74-year-old woman with a complex iatrogenic vascular injury from attempted insertion of a hemodialysis catheter: concurrent brachiocephalic artery pseudoaneurysm and common carotid artery to internal jugular vein fistula. Both lesions were excluded successfully by using two balloon-expandable covered stents with a satisfactory short-term clinical and angiographic outcome.
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http://dx.doi.org/10.1136/bcr-2015-011760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480142PMC
June 2015

Radiologic resolution of malignant infantile osteopetrosis skeletal changes following hematopoietic stem cell transplantation.

Pediatr Blood Cancer 2015 Sep 27;62(9):1645-9. Epub 2015 Mar 27.

Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Hematopoietic stem cell transplantation (HSCT) is the only known curative treatment of malignant infantile osteopetrosis (MIOP). In this study, short-term serial bone surveys were used to assess radiologic evolution of skeletal changes after HSCT in MIOP.

Materials And Methods: Baseline whole-body bone survey was performed in all patients. HSCT was successful in 14 patients (11 with full chimerism, three with mixed chimerism) in whom follow-up bone surveys were carried out at 6 and 12 months after HSCT.

Results: Normal corticomedullary differentiation was evident in five (P = 0.06) and 12 (P < 0.005) patients at 6 and 12 months, respectively. Abnormal endobone appearance in long bones, present in 11 participants at baseline exam, disappeared in eight (P = 0.008) and all (P = 0.001) patients at 6 and 12 months, respectively. In 6-month follow-up, rachitic changes significantly disappeared (P < 0.01) in long bones; however, they were evident in ribs of 12 patients (P = 0.50). No patient had rickets in ribs or long bones after 12 months.

Conclusion: We observed considerable resolution of MIOP skeletal changes after HSCT in all patients with either full or mixed chimerism. Rachitic changes in long bones, attenuated corticomedullary differentiation, and endobone appearance were the first to resolve. We propose using single long bone plain x-ray to demonstrate short-term skeletal response to HSCT.
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http://dx.doi.org/10.1002/pbc.25524DOI Listing
September 2015

Liver enzyme levels and hepatic iron content in Fatty liver: a noninvasive assessment in general population by T2* mapping.

Acad Radiol 2015 Jun 7;22(6):714-21. Epub 2015 Mar 7.

Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Avenue, Tehran 14117-13135, Iran. Electronic address:

Rationale And Objectives: Existing evidence suggests potential contribution of iron in pathogenesis of nonalcoholic fatty liver disease (NAFLD). We aimed to investigate whether hepatic iron content correlates with liver enzyme levels in NAFLD using a noninvasive magnetic resonance imaging (MRI) technique.

Materials And Methods: Subjects from Golestan Cohort Study were randomly selected. Diagnosis of NAFLD was made by combination of ultrasound and MRI. Subjects with NAFLD were divided into two groups with high (H-NAFLD) and low (L-NAFLD) enzyme level according to 95th percentile of alanine aminotransferase (ALT) value in normal population. Quantitative T2* maps of entire cross-sectional area of liver were calculated on pixel-by-pixel basis using a semiautomated software.

Results: A total of 207 subjects were enrolled. Mean T2* values were significantly lower in NAFLD group than controls (P < .001) indicating higher iron content. Male subjects with H-NAFLD had statistically lower T2* values than those with L-NAFLD in multivariate analysis (odds ratio, 0.74; 95% confidence interval [CI], 0.58-0.95), whereas this was not observed in women. Unlike women, there was significant negative correlation between ALT levels and T2* values in men with H-NAFLD (r = -0.66, P = .01). Every 1-millisecond decrement in T2* value was associated with 6.37 IU/L increase in ALT level (95% CI, 1.8-10.9, P = .01) in men with H-NAFLD.

Conclusions: Higher hepatic iron in men with H-NAFLD, estimated by T2* mapping, may support the role of iron in possible progression of simple steatosis to nonalcoholic steatohepatitis. Lack of such correlation in women could be attributed to relatively lower iron storage or other mechanisms rather than iron.
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http://dx.doi.org/10.1016/j.acra.2015.01.011DOI Listing
June 2015

Evaluation of the efficacy of once-daily use of tadalafil vs. on-demand use. Is there a cumulative effect?

J Pak Med Assoc 2012 Nov;62(11):1195-8

Department of Urology, Tehran University of Medical Science. Imam-Khomeini Hospital, Tehran, Iran.

Objective: To assess and compare the efficacy of on-demand versus daily dosages of tadalafil in the treatment of erectile dysfunction.

Methods: The case-control double-blind study was conducted at the Department of Urology, Tehran University of Medical Science, Imam Khomeini Hospital, from March 2008 to January 2010. It comprised 100 males suffering from erectile dysfunction who were randomised into two groups; one receiving on-demand tadalafil (10mg), and the other receiving once-daily dose of tadalafil (10mg). The erectile function domain of the International Index of Erectile Function was evaluated initially at the baseline and then at 24 weeks after treatment. To evaluate the possible cumulative effect of tadalafil, the index was measured in the group taking daily tadalafil at 12 weeks after the initiation of the treatment. SPSS 13 was used for statistical analysis.

Results: The study showed significant improvement in the mean erectile function domain measured after 24 weeks in both daily (17.08+/-3.896 vs baseline 12.64+/-2.92; p<0.001) and on-demand (15.46+/-3.64 vs baseline 13.48+/-2.86; p<0.001) groups. Data showed significant difference in mean scores between on-demand and daily groups (p = 0.03). In daily group, the mean domain measured at the 24th week showed significant improvement compared to the mean score of the 12th week (p <0.001).

Conclusion: Treatment with daily tadalafil was associated with a significantly higher erectile function domain score compared to the on-demand use. The significant difference between mean scores of 12th week and 24th week in the daily group points towards the possible cumulative effect of tadalafil.
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November 2012

Multiple magnet ingestion: is there a role for early surgical intervention?

Ann Saudi Med 2012 Jan-Feb;32(1):93-6

Department of Surgery, Department of Radiology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Children often swallow foreign bodies. Multiple magnet ingestion is rare, but can result in serious complications. This study presents three unique cases of multiple magnet ingestion: one case an 8-year-old boy with multiple magnet ingestion resulting in gastric obstruction and the other two cases with intestinal perforations due to multiple magnet intake. History and physical examination are unreliable in children who swallow multiple magnets. Sometimes radiological findings are not conclusive, whether one magnet is swallowed or more. If magnets are not moved in sequential radiology images, we recommend early surgical intervention before gastrointestinal complications develop. Toy companies, parents, physicians, and radiologists should be warned about the potential complications of such toys.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087655PMC
http://dx.doi.org/10.5144/0256-4947.2012.93DOI Listing
August 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

Epidemiological and clinical features of Brucella arthritis in 24 children.

Ann Saudi Med 2011 May-Jun;31(3):270-3

Department of Pediatrics, Imam Khomeini Hospital, Tehran, Iran.

Background And Objectives: Brucellosis is considered the leading zoonotic disease of the Middle East. The disease has a wide spectrum of clinical manifestations and can result in complications with severe morbidity. The aim of this study was to evaluate the frequency, distribution and characteristics of arthritis in Iranian children with brucellosis.

Design And Setting: A retrospective descriptive study conducted in a referral children center in Tehran from 1997 to 2005.

Patients And Methods: Arthritis in children with brucellosis who were admitted to a specialized hospital was detected by clinical signs of the involved joint(s) and characteristics of joint fluid aspiration. Socio-demographic information was recorded.

Results: Of 96 patients diagnosed with brucellosis, 24 (25%) had Brucella arthritis 14 (58.3%) males and 10 (41.7%) females. Most common manifestations were fever in 21 patients (87.5%) and fatigue in 18 patients (75%). Monoarthritis was recorded in 15 patients (62.5%) of the cases with involvement of the knee in 8 (45%) and hip in 5 (29%), the ankle in 2 (8%) patients while 9 (37.5%) patients suffered from polyarthritis. None of the patients had axial joints involvement. Seventy-five percent of the subjects (18 patients) were from urban areas and 66.7% (16 patients) had consumed un-pasteurized cheese. Recurrence was not seen in any of the 24 patients who received a combination of co-trimoxazole for 6 weeks and gentamicin for 5 days.

Conclusion: Childhood brucellosis is a challenging disease in Iran that has serious complications like arthritis. Therefore all physicians who work in endemic areas should be familiar with this disease and consider the possibility of brucellosis in all children who present with arthritis and arthralgia.
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http://dx.doi.org/10.4103/0256-4947.81543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119967PMC
September 2011
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