Amir H. Sarrami

All Publications

• Apparent diffusion coefficient can assist in differentiating between benign and malignant primary bone tumors in pediatric patients. Skeletal radiology Lokesha, Y. U., Singh, S. B., von Krüchten, R., Varniab, Z. S., Kumar, M., Suryadevara, V., Sarrami, A. H., Liang, T., Wong, J., Pribnow, A., Daldrup-Link, H. E. 2025

  Abstract

  To evaluate differences in apparent diffusion coefficient (ADC) values between benign and malignant primary pediatric bone tumors and to assess their diagnostic accuracy in differentiating these tumors.We retrospectively analyzed MRI scans of 96 pediatric patients (54 males, 42 females; mean age 12.97 ± 3.9 years) with primary bone tumors who underwent diffusion-weighted imaging, including 48 benign and 48 malignant tumors. We measured ADCmean, ADCmin, and ADCmax of the solid tumor part, carefully avoiding cystic, necrotic, or sclerosed tumor areas. The Wilcoxon rank-sum test was used to test the distributional difference of benign vs malignant tumors. ROC curve analysis was performed to assess the diagnostic accuracy. The optimal cutoff of ADC values to differentiate benign and malignant bone tumors was defined as the point at which the Youden index, the sum of sensitivity and specificity, was maximized.The median values of the ADCmean, ADCmin, and ADCmax for benign bone tumors [1.34 (1.13-1.83), 0.98 (0.73-1.34), and 1.80 (1.57-2.46) × 10-3mm2/s, respectively] were significantly higher compared to malignant bone tumors [0.93 (0.78-1.03), 0.59 (0.43-0.72), and 1.35 (1.22-1.66) × 10-3mm2/s, respectively; all p < 0.05]. ADCmean yielded the highest diagnostic accuracy, with an optimal cutoff of 1.04 (0.94-1.15) × 10-3mm2/s (sensitivity 77%, specificity 93%, AUC = 0.91). An ADCmin cutoff of 0.82 (0.65-0.98) × 10-3mm2/s resulted in a sensitivity of 87.5%, specificity of 70.0%, and AUC of 0.85. An ADCmax cutoff of 1.48 (1.18-1.78) × 10-3mm2/s achieved a sensitivity of 68%, specificity of 81%, and AUC of 0.80.ADCmean, ADCmin, and ADCmax differ significantly between benign and malignant pediatric bone tumors, and the ADCmean provides the highest diagnostic accuracy.

  View details for DOI 10.1007/s00256-025-05060-8

  View details for PubMedID 41160129

  View details for PubMedCentralID 11099578

• Applications of Artificial Intelligence for Pediatric Cancer Imaging. AJR. American journal of roentgenology Singh, S. B., Sarrami, A. H., Gatidis, S., Varniab, Z. S., Chaudhari, A., Daldrup-Link, H. E. 2024

  Abstract

  Artificial intelligence (AI) is transforming medical imaging of adult patients. However, its utilization in pediatric oncology imaging remains constrained, in part due to the inherent data scarcity associated with childhood cancers. Pediatric cancers are rare, and imaging technologies are evolving rapidly, leading to insufficient data of a particular type to effectively train these algorithms. The small market size of pediatrics compared to adults could also contribute to this challenge, as market size is a driver of commercialization. This article provides an overview of the current state of AI applications for pediatric cancer imaging, including applications for medical image acquisition, processing, reconstruction, segmentation, diagnosis, staging, and treatment response monitoring. While current developments are promising, impediments due to diverse anatomies of growing children and nonstandardized imaging protocols have led to limited clinical translation thus far. Opportunities include leveraging reconstruction algorithms to achieve accelerated low-dose imaging and automating the generation of metric-based staging and treatment monitoring scores. Transfer-learning of adult-based AI models to pediatric cancers, multi-institutional data sharing, and ethical data privacy practices for pediatric patients with rare cancers will be keys to unlocking AI's full potential for clinical translation and improved outcomes for these young patients.

  View details for DOI 10.2214/AJR.24.31076

  View details for PubMedID 38809123

• Comparison of diffusion-weighted MRI and [18F]FDG PET/MRI for treatment monitoring in pediatric Hodgkin and non-Hodgkin lymphoma. European radiology Morakote, W., Baratto, L., Ramasamy, S. K., Adams, L. C., Liang, T., Sarrami, A. H., Daldrup-Link, H. E. 2023

  Abstract

  To compare tumor therapy response assessments with whole-body diffusion-weighted imaging (WB-DWI) and 18F-fluorodeoxyglucose ([18F]FDG) PET/MRI in pediatric patients with Hodgkin lymphoma and non-Hodgkin lymphoma.In a retrospective, non-randomized single-center study, we reviewed serial simultaneous WB-DWI and [18F]FDG PET/MRI scans of 45 children and young adults (27 males; mean age, 13 years ± 5 [standard deviation]; age range, 1-21 years) with Hodgkin lymphoma (n = 20) and non-Hodgkin lymphoma (n = 25) between February 2018 and October 2022. We measured minimum tumor apparent diffusion coefficient (ADCmin) and maximum standardized uptake value (SUVmax) of up to six target lesions and assessed therapy response according to Lugano criteria and modified criteria for WB-DWI. We evaluated the agreement between WB-DWI- and [18F]FDG PET/MRI-based response classifications with Gwet's agreement coefficient (AC).After induction chemotherapy, 95% (19 of 20) of patients with Hodgkin lymphoma and 72% (18 of 25) of patients with non-Hodgkin lymphoma showed concordant response in tumor metabolism and proton diffusion. We found a high agreement between treatment response assessments on WB-DWI and [18F]FDG PET/MRI (Gwet's AC = 0.94; 95% confidence interval [CI]: 0.82, 1.00) in patients with Hodgkin lymphoma, and a lower agreement for patients with non-Hodgkin lymphoma (Gwet's AC = 0.66; 95% CI: 0.43, 0.90). After completion of therapy, there was an excellent agreement between WB-DWI and [18F]FDG PET/MRI response assessments (Gwet's AC = 0.97; 95% CI: 0.91, 1).Therapy response of Hodgkin lymphoma can be evaluated with either [18F]FDG PET or WB-DWI, whereas patients with non-Hodgkin lymphoma may benefit from a combined approach.Hodgkin lymphoma and non-Hodgkin lymphoma exhibit different patterns of tumor response to induction chemotherapy on diffusion-weighted MRI and PET/MRI.• Diffusion-weighted imaging has been proposed as an alternative imaging to assess tumor response without ionizing radiation. • After induction therapy, whole-body diffusion-weighted imaging and PET/MRI revealed a higher agreement in patients with Hodgkin lymphoma than in those with non-Hodgkin lymphoma. • At the end of therapy, whole-body diffusion-weighted imaging and PET/MRI revealed an excellent agreement for overall tumor therapy responses for all lymphoma types.

  View details for DOI 10.1007/s00330-023-10015-5

  View details for PubMedID 37542653

  View details for PubMedCentralID 4461807

• Radiomics; A Potential Next "Omics" in Psychiatric Disorders; An Introduction PSYCHIATRY INVESTIGATION Alizadeh, M., Tanwar, M., Sarrami, A. H., Shahidi, R., Singhal, A., Sotoudeh, H. 2023

  Abstract

  Psychiatric disorders remain one of the most debilitating conditions; however, most patients are never diagnosed and do not seek treatment. Despite its massive burden on modern society and the health system, many hurdles prevent proper diagnosis and management of these disorders. The diagnosis is primarily based on clinical symptoms, and efforts to find appropriate biomarkers have not been practical. Through the past years, researchers have put a tremendous effort into finding biomarkers in "omics" fields: genomics, transcriptomics, proteomics, metabolomics, and epigenomics. This article reviews the evolving field of radiomics and its role in diagnosing psychiatric disorders as the sixth potential "omics." The first section of this paper elaborates on the definition of radiomics and its potential to provide a detailed structural study of the brain. Following that, we have provided the latest promising results of this novel approach in a broad range of psychiatric disorders. Radiomics fits well within the concept of psychoradiology. Besides volumetric analysis, radiomics takes advantage of many other features. This technique may open a new field in psychiatry for diagnosing and classifying psychiatric disorders and treatment response prediction in the era of precision and personalized medicine. The initial results are encouraging, but radiomics in psychiatry is still in its infancy. Despite the extensive burden of psychiatric disorders, there are very few published studies in this field, with small patient populations. The lack of prospective multi-centric studies and heterogeneity of studies in design are the significant barriers against the clinical adaptation of radiomics in psychoradiology.

  View details for DOI 10.30773/pi.2022.0336

  View details for Web of Science ID 001023801700001

  View details for PubMedID 37409371

• Comparison of whole-body DW-MRI with 2-[18F]FDG PET for staging and treatment monitoring of children with Langerhans cell histiocytosis. European journal of nuclear medicine and molecular imaging Baratto, L., Nyalakonda, R., Theruvath, A. J., Sarrami, A. H., Hawk, K. E., Rashidi, A., Shen, S., States, L., Aboian, M., Jeng, M., Daldrup-Link, H. E. 2023

  Abstract

  PURPOSE: To assess and compare the diagnostic accuracy of whole-body (WB) DW-MRI with 2-[18F]FDG PET for staging and treatment monitoring of children with Langerhans cell histiocytosis (LCH).METHODS: Twenty-three children with LCH underwent 2-[18F]FDG PET and WB DW-MRI at baseline. Two nuclear medicine physicians and two radiologists independently assessed presence/absence of tumors in 8 anatomical areas. Sixteen children also performed 2-[18F]FDG PET and WB DW-MRI at follow-up. One radiologist and one nuclear medicine physician revised follow-up scans and collected changes in tumor apparent diffusion (ADC) and standardized uptake values (SUV) before and after therapy in all detectable lesions. 2-[18F]FDG PET results were considered the standard of reference for tumor detection and evaluation of treatment response according to Lugano criteria. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of WB DW-MRI at baseline were calculated, and the 95% confidence intervals were estimated by using the Clopper-Pearson (exact) method; changes in tumor SUVs and ADC were compared using a Mann-Whitney U test. Agreement between reviewers was assessed with a Cohen's weighted kappa coefficient. Analyses were conducted using SAS software version 9.4.RESULTS: Agreement between reviewers was perfect (kappa coefficient=1) for all analyzed regions but spine and neck (kappa coefficient=0.89 and 0.83, respectively) for 2-[18F]FDG PET images, and abdomen and pelvis (kappa coefficient=0.65 and 0.88, respectively) for WB DW-MRI. Sensitivity and specificity were 95.5% and 100% for WB DW-MRI compared to 2-[18F]FDG PET. Pre to post-treatment changes in SUVratio and ADCmean were inversely correlated for all lesions (r: -0.27, p=0·06) and significantly different between responders and non-responders to chemotherapy (p=0.0006 and p=0·003 for SUVratio and ADCmean, respectively).CONCLUSION: Our study showed that WB DW-MRI has similar accuracy to 2-[18F]FDG PET for staging and treatment monitoring of LCH in children. While 2-[18F]FDG PET remains an approved radiological examination for assessing metabolically active disease, WB DW-MRI could be considered as an alternative approach without radiation exposure. The combination of both modalities might have advantages over either approach alone.

  View details for DOI 10.1007/s00259-023-06122-6

  View details for PubMedID 36717409

• Low-count whole-body PET/MRI restoration: an evaluation of dose reduction spectrum and five state-of-the-art artificial intelligence models. European journal of nuclear medicine and molecular imaging Wang, Y. J., Wang, P., Adams, L. C., Sheybani, N. D., Qu, L., Sarrami, A. H., Theruvath, A. J., Gatidis, S., Ho, T., Zhou, Q., Pribnow, A., Thakor, A. S., Rubin, D., Daldrup-Link, H. E. 2023

  Abstract

  To provide a holistic and complete comparison of the five most advanced AI models in the augmentation of low-dose 18F-FDG PET data over the entire dose reduction spectrum.In this multicenter study, five AI models were investigated for restoring low-count whole-body PET/MRI, covering convolutional benchmarks - U-Net, enhanced deep super-resolution network (EDSR), generative adversarial network (GAN) - and the most cutting-edge image reconstruction transformer models in computer vision to date - Swin transformer image restoration network (SwinIR) and EDSR-ViT (vision transformer). The models were evaluated against six groups of count levels representing the simulated 75%, 50%, 25%, 12.5%, 6.25%, and 1% (extremely ultra-low-count) of the clinical standard 3 MBq/kg 18F-FDG dose. The comparisons were performed upon two independent cohorts - (1) a primary cohort from Stanford University and (2) a cross-continental external validation cohort from Tübingen University - in order to ensure the findings are generalizable. A total of 476 original count and simulated low-count whole-body PET/MRI scans were incorporated into this analysis.For low-count PET restoration on the primary cohort, the mean structural similarity index (SSIM) scores for dose 6.25% were 0.898 (95% CI, 0.887-0.910) for EDSR, 0.893 (0.881-0.905) for EDSR-ViT, 0.873 (0.859-0.887) for GAN, 0.885 (0.873-0.898) for U-Net, and 0.910 (0.900-0.920) for SwinIR. In continuation, SwinIR and U-Net's performances were also discreetly evaluated at each simulated radiotracer dose levels. Using the primary Stanford cohort, the mean diagnostic image quality (DIQ; 5-point Likert scale) scores of SwinIR restoration were 5 (SD, 0) for dose 75%, 4.50 (0.535) for dose 50%, 3.75 (0.463) for dose 25%, 3.25 (0.463) for dose 12.5%, 4 (0.926) for dose 6.25%, and 2.5 (0.534) for dose 1%.Compared to low-count PET images, with near-to or nondiagnostic images at higher dose reduction levels (up to 6.25%), both SwinIR and U-Net significantly improve the diagnostic quality of PET images. A radiotracer dose reduction to 1% of the current clinical standard radiotracer dose is out of scope for current AI techniques.

  View details for DOI 10.1007/s00259-022-06097-w

  View details for PubMedID 36633614

• Multimodal Pediatric Lymphoma Detection using PET and MRI. AMIA ... Annual Symposium proceedings. AMIA Symposium Wang, H., Sarrami, A., Wu, J. T., Baratto, L., Sharma, A., Wong, K. C., Singh, S. B., Daldrup-Link, H. E., Syeda-Mahmood, T. 2023; 2023: 736-743

  Abstract

  Lymphoma is one of the most common types of cancer for children (ages 0 to 19). Due to the reduced radiation exposure, PET/MR systems that allow simultaneous PET and MR imaging have become the standard of care for diagnosing cancers and monitoring tumor response to therapy in the pediatric population. In this work, we developed a multimodal deep learning algorithm for automatic pediatric lymphoma detection using PET and MRI. Through innovative designs such as standardized uptake value (SUV) guided tumor candidate generation, location aware classification model learning and weighted multimodal feature fusion, our algorithm can be effectively trained with limited data and achieved superior tumor detection performance over the state-of-the-art in our experiments.

  View details for PubMedID 38222333

  View details for PubMedCentralID PMC10785920

• Association between Extracranial Carotid Artery Plaque and Cognitive Dysfunction: A Systematic Review and Meta-Analysis DEMENTIA AND GERIATRIC COGNITIVE DISORDERS Baradaran, H., Dahlstrom, K. A., Culleton, S., Sarrami, A., McFarland, M. M., Romero, J. R. 2022: 1-9

  Abstract

  Extracranial carotid atherosclerosis has been variably associated with dementia. Prior studies have focused on the association of carotid intima media thickness or carotid stenosis; however, there is evidence that carotid plaque may contribute to dementia, perhaps via microembolic phenomena.We sought to evaluate the role of carotid plaque in contributing to cognitive impairment by performing a systematic review and meta-analysis to summarize the association between extracranial carotid plaque and cognitive dysfunction and dementia.We performed a comprehensive literature search evaluating the association of extracranial carotid plaque with cognition. We included studies measuring carotid plaque on ultrasound, computed tomography, or MR and also evaluated cognition through neuropsychological testing. Meta-analyses with assessment of study heterogeneity and publication bias were performed. Results were presented in a forest plot and summarized using a random-effects model.After screening 1,674 studies, we included 40 for systematic review and 16 and 7 studies for two meta-analyses with a total of 19,029 and 27,325 patients, respectively. We found a positive relationship between the presence of extracranial carotid plaque and cognitive dysfunction with a pooled random-effects odds ratio (OR) of 1.83 (95% CI, 1.50, 2.24) and a pooled random-effects hazard ratio (HR) of 1.47 (95% CI, 1.15, 1.89), respectively. A sensitivity analysis of only longitudinal studies found a persistent positive association. Measures of heterogeneity showed moderate heterogeneity in each meta-analysis, respectively (I-squared statistic = 57% and 70%).The presence of extracranial carotid plaque is significantly associated with cognitive dysfunction and dementia in both cross-sectional and longitudinal analyses. After further confirmation, our results support carotid plaque being a potentially modifiable risk factor in the development of dementia.

  View details for DOI 10.1159/000526822

  View details for Web of Science ID 000879832100001

  View details for PubMedID 36316004

• PET AND MRI IMAGING-BASED AI MODELS IN PEDIATRIC ONCOLOGY Baratto, L., Wang, Y., Theruvath, A., Sarrami, A., Sheybani, N., Hawk, K., Daldrup-Link, H. SOC NUCLEAR MEDICINE INC. 2022

  View details for Web of Science ID 000893739700076

• Idiopathic intracranial hypertension imaging approaches and the implications in patient management. The British journal of radiology Sarrami, A. H., Bass, D. I., Rutman, A. M., Alexander, M. D., Aksakal, M., Zhu, C., Levitt, M. R., Mossa-Basha, M. 2022: 20220136

  Abstract

  Idiopathic intracranial hypertension (IIH) represents a clinical disease entity without a clear etiology, that if left untreated, can result in severe outcomes, including permanent vision loss. For this reason, early diagnosis and treatment is necessary. Historically, the role of cross-sectional imaging has been to rule out secondary or emergent causes of increased intracranial pressure, including tumor, infection, hydrocephalus, or venous thrombosis. MRI and MRV, however, can serve as valuable imaging tools to not only rule out causes for secondary intracranial hypertension but can also detect indirect signs of IIH resultant from increased intracranial pressure, and demonstrate potentially treatable sinus venous stenosis. Digital subtraction venographic imaging also plays a central role in both diagnosis and treatment, providing enhanced anatomic delineation and temporal flow evaluation, quantitative assessment of the pressure gradient across a venous stenosis, treatment guidance, and immediate opportunity for endovascular therapy. In this review, we discuss the multiple modalities for imaging IIH, their limitations, and their contributions to the management of IIH.

  View details for DOI 10.1259/bjr.20220136

  View details for PubMedID 35522777

• Assessment of Recurrent Stroke Risk in Patients With a Carotid Web JAMA NEUROLOGY Guglielmi, V., Compagne, K. C. J., Sarrami, A., Sluis, W. M., van den Berg, L. A., van der Sluijs, P. M., Mandell, D. M., van der Lugt, A., Roos, Y. M., Majoie, C. M., Dippel, D. W. J., Emmer, B. J., van Es, A. M., Coutinho, J. M., MR CLEAN Trial MR CLEAN Registry 2021; 78 (7): 826-833

  Abstract

  A carotid web (CW) is a shelf-like lesion along the posterior wall of the internal carotid artery bulb and an underrecognized cause of young stroke. Several studies suggest that patients with symptomatic CW have a high risk of recurrent stroke, but high-quality data are lacking.To assess the 2-year risk of recurrent stroke in patients with a symptomatic CW.A comparative cohort study used data from the MR CLEAN trial (from 2010-2014) and MR CLEAN Registry (from 2014-2017). Data were analyzed in September 2020. The MR CLEAN trial and MR CLEAN Registry were nationwide prospective multicenter studies on endovascular treatment (EVT) of large vessel occlusion (LVO) stroke in the Netherlands. Baseline data were from 3439 consecutive adult patients with anterior circulation LVO stroke and available computed tomography (CT)-angiography of the carotid bulb. Two neuroradiologists reevaluated CT-angiography images for presence or absence of CW and identified 30 patients with CW ipsilateral to the index stroke. For these 30 eligible CW participants, detailed follow-up data regarding stroke recurrence within 2 years were acquired. These 30 patients with CW ipsilateral to the index stroke were compared with 168 patients without CW who participated in the MR CLEAN extended follow-up trial and who were randomized to the EVT arm.The primary outcome was recurrent stroke occurring within 2 years after the index stroke. Cox proportional hazards regression models were used to compare recurrent stroke rates within 2 years for patients with and without CW, adjusted for age and sex. The research question was formulated prior to data collection.Of 3439 patients with baseline CT-angiography assessed, the median age was 72 years (interquartile range, 61-80 years) and 1813 (53%) were men. Patients with CW were younger (median age, 57 [interquartile range, 46-66] years vs 66 [interquartile range, 56-77] years; P = .02 and more often women (22 of 30 [73%] vs 67 of 168 [40%]; P = .001) than patients without CW. Twenty-eight of 30 patients (93%) received medical management after the index stroke (23 with antiplatelet therapy and 5 with anticoagulant therapy). During 2 years of follow-up, 5 of 30 patients (17%) with CW had a recurrent stroke compared with 5 of 168 patients (3%) without CW (adjusted hazard ratio, 4.9; 95% CI, 1.4-18.1).In this study, 1 of 6 patients with a symptomatic CW had a recurrent stroke within 2 years, suggesting that medical management alone may not provide sufficient protection for patients with CW.

  View details for DOI 10.1001/jamaneurol.2021.1101

  View details for Web of Science ID 000650217500002

  View details for PubMedID 33970205

  View details for PubMedCentralID PMC8111564

• Current Status and Quality of Machine Learning-Based Radiomics Studies for Glioma Grading: A Systematic Review ONCOLOGY Tabatabaei, M., Razaei, A., Sarrami, A., Saadatpour, Z., Singhal, A., Sotoudeh, H. 2021: 433-443

  Abstract

  Radiomics now has significant momentum in the era of precision medicine. Glioma is one of the pathologies that has been extensively evaluated by radiomics. However, this technique has not been incorporated into clinical practice. In this systematic review, we selected and reviewed the published studies about glioma grading by radiomics to evaluate this technique's feasibility and its challenges.Using seven different search strings, we considered all published English manuscripts from 2015 to September 2020 in PubMed, Embase, and Scopus databases. After implementing the exclusion and inclusion criteria, the final papers were selected for the methodological quality assessment based on our in-house Modified Radiomics Standard Scoring (RQS) containing 43 items (minimum score of 0, maximum score of 44). Finally, we offered our opinion about the challenges and weaknesses of the selected papers.By our search, 1,177 manuscripts were found (485 in PubMed, 343 in Embase, and 349 in Scopus). After the implementation of inclusion and exclusion criteria, 18 papers remained for the final analysis by RQS. The total RQS score ranged from 26 (59% of maximum possible score) to 43 (97% of maximum possible score) with a mean of 33.5 (76% of maximum possible score).The current studies are promising but very heterogeneous in design with high variation in the radiomics software, the number of extracted features, the number of selected features, and machine learning models. All of the studies were retrospective in design; many are based on small datasets and/or suffer from class imbalance and lack of external validation data-sets.

  View details for DOI 10.1159/000515597

  View details for Web of Science ID 000640284500001

  View details for PubMedID 33849021

• Susceptibility-Weighted Imaging in Neurodegenerative Disorders: A Review JOURNAL OF NEUROIMAGING Sotoudeh, H., Sarrami, A., Wang, J., Saadatpour, Z., Razaei, A., Gaddamanugu, S., Choudhary, G., Shafaat, O., Singhal, A. 2021; 31 (3): 459-470

  Abstract

  As human life expectancy increases, there is an increased prevalence of neurodegenerative disorders and dementia. There are many ongoing research trials for early diagnosis and management of dementia, and neuroimaging is a critical part of such studies. However, conventional neuroimaging often fails to provide enough diagnostic findings in patients with neurodegenerative disorders. In this context, different MRI sequences are currently under investigation to facilitate the accurate diagnosis of such disorders. Susceptibility-weighted imaging (SWI) is an innovative MRI technique that utilizes "magnitude" and "phase" images to produce an image contrast that is sensitive for the detection of susceptibility differences of the tissues. As many neurodegenerative disorders are associated with accelerated iron deposition and/or microhemorrhages in different parts of the brain, SWI can be applied to detect these diagnostic clues. For instance, in cerebral amyloid angiopathy, SWI can demonstrate cortical microhemorrhages, which are predominantly in the frontal and parietal regions. Or in Parkinson disease, abnormal swallow-tail sign on high-resolution SWI is highly diagnostic. Also, SWI is a useful sequence to detect the low signal intensity of precentral cortices in patients with amyotrophic lateral sclerosis. Being familiar with SWI findings in neurodegenerative disorders is critical for an accurate diagnosis. In this paper, the authors review the technical parameters of SWI, physiologic, and pathologic iron deposition in the brain, and the role of SWI in the evaluation of neurodegenerative disorders in daily practice.

  View details for DOI 10.1111/jon.12841

  View details for Web of Science ID 000620843700001

  View details for PubMedID 33624404

• How may Doppler indices help in the differentiation of obstructive from nonobstructive hydronephrosis? JOURNAL OF RESEARCH IN MEDICAL SCIENCES Riahinezhad, M., Sarrami, A., Gheisari, A., Shafaat, O., Merikhi, A., Karami, M., Farghadani, M., Moslehi, M. 2018; 23: 76

  Abstract

  We assess the potency of different Doppler indices in the differentiation of obstructive and nonobstructive hydronephrosis.In this study, infants and children who were referred for the evaluation of unilateral hydronephrosis were enrolled. Ultrasonography for the assessment of the degree of hydronephrosis and a voiding cystourethrogram for the exclusion of vesicoureteral reflux was performed. Then, Doppler ultrasonography was done for both kidneys of each patient using four classic Doppler indices as well as the difference (delta) of each index between to kidneys. Diuretic renography with 99 mTc-ethylene dicysteine (99 mTc-EC) was performed for each patient.Thirty-nine patients met the inclusion criteria. After diuretic renography, 29 (74.35%) patients had shown a nonobstructive pattern, and ten (25.65%) patients had a partial (intermediate) or complete obstruction. Using receiver operating characteristic (ROC) curve, none of the classic indices of Doppler duplex (i.e., resistive index [RI], resistance index, end diastolic velocity, and peak systolic velocity) had the ability to make a difference between obstructive and nonobstructive hydronephrosis. However, by calculating the difference (delta) of these indices between two kidneys of each patient, delta RI could differentiate the nonobstructive condition, significantly (P = 0.006). A cutoff value of 0.055 has 60% sensitivity and 82.8% specificity. The area under the ROC curve for delta RI is 0.795 (standard error: 0.086, 95% confidence interval [CI]: 0.626, 0.964). Furthermore, RI ratio between two kidneys of each patient could differentiate the nonobstructive condition, significantly (P = 0.012). A cutoff point of 1.075 has 70% sensitivity and 82.8% specificity. The area under the ROC curve for RI ratio was 0.769 (standard error: 0.104, 95% CI: 0.565, 0.973).This study shows that RI ratio and delta RI with a high specificity could differentiate nonobstructive hydronephrosis and therefore it is a promising way to use especially in the follow-up of children with hydronephrosis.

  View details for DOI 10.4103/jrms.JRMS_627_17

  View details for Web of Science ID 000444511500008

  View details for PubMedID 30181758

  View details for PubMedCentralID PMC6116660

• Phase sensitive reconstruction of T1-weighted inversion recovery in the evaluation of the cervical cord lesions in Multiple Sclerosis; is it similarly eligible in 1.5 T magnet fields? MULTIPLE SCLEROSIS AND RELATED DISORDERS Shayganfar, A., Sarrami, A. H., Fathi, S., Shaygannejad, Shamsian, S. 2018; 23: 17-22

  Abstract

  In primary studies with 3 T Magnets, phase sensitive reconstruction of T1-weighted inversion recovery (PSIR) have showed ability to depict the cervical multiple sclerosis (MS) lesions some of which may not be detected by short tau inversion recovery (STIR). Regarding to more availability of 1.5 T MRI, this study was designed to evaluate the eligibility of PSIR in 1.5 T for detection of spinal cord MS lesions.In a study between September 2016 till March 2017 the patients with proven diagnosis of MS enrolled to the study. The standard protocol (sagittal STIR and T2W FSE and axial T2W FSE) as well as sagittal PSIR sequences were performed using a 1.5 T magnet. The images were studied and the lesions were localized and recorded as sharp or faint on each sequence.Of 25 patients (22 females and 3 males, with mean age of 33.5 ± 9.8 years and mean disease duration of 5.4 ± 3.9 years) 69 lesions in STIR, 53 lesions in T2W FSE, 47 lesions in Magnitude reconstruction of PSIR (Magnitude), and 30 lesions in phase sensitive (real) reconstruction PSIR were detected. A Wilcoxon signed-rank test showed STIR has a statistically significant higher detection rate of the plaques rather than other three sequences. (STIR and T2W FSE, Z = -4.000, p < 0.0001, STIR and Magnitude, Z = -4.690, p < 0.0001, STIR and PSIR, Z = -6.245, p = 0.002) Also, STIR had a statistically significant superiority in the boundary definition of the plaques rather than other three sequences.This study shows that in the setting of a 1.5 T magnet field, STIR significantly has a superiority over both of the PSIR reconstructions (i.e. real and magnitude) for the detection as well as the boundary definition of the cervical cord lesions of MS. These results have a good relevance to clinical practice by using MRI scanners and sequences routinely available, however, it is discrepant with other reports performed by 3 T Magnet fields.

  View details for DOI 10.1016/j.msard.2018.04.013

  View details for Web of Science ID 000439585600007

  View details for PubMedID 29730588

• Is there any Correlation between Magnetic Resonance Imaging Features of Breast Lesions of BIRADS Category 4 with Histopathologic Results? Advanced biomedical research Farghadani, M., Soofi, G. J., Sarrami, A. H. 2017; 6: 7

  Abstract

  BACKGROUND: To evaluate the correlation of magnetic resonance imaging (MRI) features of breast lesions of Breast Imaging Reporting and Database System (BI-RADS) category 4 with histopathologic results.MATERIALS AND METHODS: In a prospective study between December 2013 and April 2015, patients with suspicious mammographic and/or ultrasound findings referred for Breast MRI were evaluated. Patients with lesions of BI-RADS category 4 were enrolled with a written informed consent. In each patient, mass lesion (ML) or nonmass lesion (NML) was determined, and different characteristics of the lesions were recorded. A follow-up program was taken with mean 3-12 months. Patients who underwent core needle biopsy or open biopsy were summoned.RESULTS: Seventy-eight females aged 24-67 years (mean 43.1 ± 8.8) met the inclusion criteria and had adequate samples for histopathologic study. Twenty-nine (37.2%) patients had ML and 49 (62.8%) patients had NML. Tissue sampling in 63 (80.7%) patients was through core needle biopsy and in 15 (19.2%) patients through surgery. A wide spectrum of benign and malignant pathologic diagnoses was seen. In statistical analysis, none of the MRI features has a significant correlation with any specific histopathologic diagnosis (P = 0.185). However, the relation between the MRI category (ML or NML) and pathology results was significant at level of 0.1 (P = 0.06).CONCLUSION: This study showed that a wide spectrum of histopathologic results is seen in BI-RADS category 4. However, in this sample volume, none of the MRI features in this BI-RADS category has a significant correlation with any specific histopathologic diagnosis.

  View details for DOI 10.4103/2277-9175.199258

  View details for PubMedID 28217652

• Resolution of aspergillosis in neuroimaging of an immunocompromised patient with pulmonary and cerebral lesions. Asian journal of neurosurgery Meidani, M., Hakamifard, A., Sarrami, A. H. 2016; 11 (4): 456

  Abstract

  Central nervous system (CNS) aspergillosis is uncommon and considered the most lethal form of aspergillosis. Indeed, current therapeutic strategies such as combination antifungal regimen, neurosurgical resection of infected tissue, and removal of infection source fail to improve the unsatisfactory prognosis of CNS aspergillosis in the majority of the patients. The authors describe a case of chronic pulmonary aspergillosis with concomitant CNS lesions that dramatically responded to antifungal therapy and the CNS lesions resolved in follow-up imaging.

  View details for PubMedID 27695571

• Computed tomography-guided percutaneous core needle biopsy for diagnosis of mediastinal mass lesions: Experience with 110 cases in two university hospitals in Isfahan, Iran. Advanced biomedical research Rabbani, M., Sarrami, A. H. 2016; 5: 152

  Abstract

  BACKGROUND: Computed tomography-guided percutaneous core needle biopsy (PCNB) is a diagnostic technique for initial assessment of mediastinal mass lesions. This study was conducted to evaluate its diagnostic yield and its complication rate.MATERIALS AND METHODS: We reviewed the records of CT-guided PCNB in 110 patients with mediastinal mass lesions performed in Kashani and Alzahra Hospitals, Isfahan, from 2006 to 2012. Gender, age at biopsy, size, and anatomic location of the lesion, number of passes, site of approach, complications, and final diagnosis were extracted.RESULTS: Our series encompasses 52 (47.2%) females and 58 (52/7%) males with mean age of 41 ± 8 years. The most common site of involvement was the anterior mediastinum (91.8% of cases). An average of 3/5 passes per patient has been taken for tissue sampling. Parasternal site was the most frequent approach taken for PCNB (in 78.1% of cases). Diagnostic tissue was obtained in 99 (90%) biopsies while, in 11 (10%) cases, specimen materials were inadequate. Lymphoma (49.5%) and bronchogenic carcinoma (33.3%) were the most frequent lesions in our series. The overall complication rate was 17.2% from which 10.9% was pneumothorax, 5.4% was hemoptysis, and 0.9% was vasovagal reflex.CONCLUSION: CT-guided PCNB is a safe and reliable procedure that can provide a precise diagnosis for patients with both benign and malignant mediastinal masses, and it is considered the preferred first diagnostic procedure use for this purpose.

  View details for PubMedID 27713873

• Usefulness of combination of grey-scale and color Doppler ultrasound findings in the diagnosis of ulnar nerve entrapment syndrome JOURNAL OF RESEARCH IN MEDICAL SCIENCES Ghanei, M., Karami, M., Zarezadeh, A., Sarrami, A. 2015; 20 (4): 342-345

  Abstract

  Ulnar nerve entrapment (UNE) has been diagnosed with clinical examination and electrodiagnostic studies. This study was designed to determine the value of a combination of grey-scale and color Doppler ultrasound findings in the diagnosis of patients with UNE.During May to August 2013 41 patients with UNE (proven by electrodiagnostic studies) and 44 healthy volunteers were evaluated by ultrasound study. Three cross-sectional area (CSA) of ulnar nerve around cubital fossa was determined and measured in both groups. The maximum and minimum diameter of ulnar nerve was measured for calculating flattening ratio index (FRI). Vascularity of ulnar nerve around cubital fossa was also examined in proper color Doppler setting.The mean CSA of nerve at all proximal, middle and distal levels were greater in patients with UNE than in controls (P = 0.02, <0.001 and 0.34 respectively). A cut-off point of 10.5 mm(2) for CSA (in the level of the cubital fossa) yielded a sensitivity and specificity of 92.7% and 93.2%, respectively. Mean FRI was 3.1 ± 0.6 in patients with UNE group and 1.4 ± 0.2 in the control group with a significant difference (P < 0.001). FRI with cutoff point 2.15 has been shown as an important parameter for the detection of UNE. The vascularity in UNE has a sensitivity and specificity of 66% and 93.2%, respectively, and has a higher probability of being positive in severe UNE.Combination of grey-scale and color Doppler ultrasound may provide valuable diagnostic criteria and severity assessment of UNE.

  View details for Web of Science ID 000357264500005

  View details for PubMedID 26109988

  View details for PubMedCentralID PMC4468448

• Absence of canalicular undescended testis during follow-up; where should be examined by ultrasound? JOURNAL OF RESEARCH IN MEDICAL SCIENCES Riahinezhad, M., Sarrami, A. 2015; 20 (3): 320

  View details for Web of Science ID 000355264000020

  View details for PubMedID 26109983

  View details for PubMedCentralID PMC4468241

• Two unusual sites of cystic lymphangioma in a child: A report of imaging profile with surgical and histopathologic findings. Advanced biomedical research Riahinezhad, M., Sarrami, A. H., Shariat, Z., Taghizadeh, F. 2015; 4: 169

  Abstract

  Cystic lymphangioma (CL) is a benign lymphatic malformation mostly seen in the head and neck of neonates and infants. Abdominal CL is an unusual entity which may present in omentum, mesentery, abdominal wall, or solid organs. The authors present an unusual case with two separate abdominal cystic lymphangiomas.

  View details for DOI 10.4103/2277-9175.162546

  View details for PubMedID 26436083

• Prevalence and Prognosis of Cerebrovascular Accidents and its Subtypes Among Patients with Systemic Lupus Erythematosus in Isfahan, Iran: A Hospital Clinic-based Study INTERNATIONAL JOURNAL OF PREVENTIVE MEDICINE Saadatnia, M., Sayed-Bonakdar, Z., Mohammad-Sharifi, G., Sarrami, A. 2014; 5 (1): 123-126

  Abstract

  The aim of the present study was to determine the prevalence and prognosis of cerebrovascular accident (CVA) and its subtypes among Iranian patients with systemic lupus erythematosus (SLE).In a cross-sectional study, medical records of 575 SLE patients were reviewed. The patients developing CVA in their course of disease were extracted. In these patients, data about demographic features, lupus anti bodies, duration of the disease until CVA, CVA manifestation(s) and follow-up duration were gathered. In the next step, patients with any kinds of CVA were summoned to Neurology clinic to identify the grade of disability in each patient with CVA.We identified 38 patients with CVA of which 6 (15.8%) were men and 32 (84.2%) were women. The most common subtype of CVA was small vessels thrombosis (21.05%) among the study patients and hemi paresis was the most prevalent initial presentation (39.47%). In 11 (28.9%) patients, SLE was initiated with CVA and in 3 (7.9%) patients CVA had happened in the 1(st) year of SLE. Anti-phospholipid antibodies (APLA) were positive in 29 (76.3%) patients. Mean modified Rankin Scale in patient with positive and negative serology for APLA was 0.93 ± 1.11 and 0.22 ± 0.66 respectively (P = 0.006).Our study shows that 6.6% of Iranian SLE patients have CVA during their course of the disease. Small vessels thrombosis is the most common CVA subtype and hemi paresis is the most prevalent initial presentation. Moreover, we showed that the prognosis of CVA in Iranian SLE patients is not unfavorable.

  View details for Web of Science ID 000214128600018

  View details for PubMedID 24555002

  View details for PubMedCentralID PMC3915465

• Fatal disseminated mucormycosis in an immunocompotent patient: a case report and literature review. International journal of preventive medicine Sarrami, A. H., Setareh, M., Izadinejad, M., Afshar-Moghaddam, N., Baradaran-Mahdavi, M. M., Meidani, M. 2013; 4 (12): 1468-71

  Abstract

  Disseminated mucormycosis is a rare entity most frequently seen in neutropenic patients with hematologic malignancies, post transplants or in patients on deferoxamine therapy. We report a 64-year-old immunocompetent male with an acute pneumonia and a generalized jaundice who died within 24 h. In the autopsy, extensive perforations of spleen and multiple hemorrhage foci on the pancreas were two significant findings. Histopathological study of tissue sections revealed typical zygomycetes hyphae in the left lung, pancreas, spleen and brain. Involvement of pancreas in this patient was one of the rare features of mucormycosis reported occasionally in the literature. Our case implies an unusual clinical presentation of disseminated mucormycosis and highlights that disseminated mucormycosis should be regarded even in the immunocompetent patients.

  View details for PubMedID 24498504

• Fatal Disseminated Mucormycosis in an Immunocompotent Patient: A Case Report and Literature Review INTERNATIONAL JOURNAL OF PREVENTIVE MEDICINE Sarrami, A., Setareh, M., Izadinejad, M., Afshar-Moghaddam, N., Baradaran-Mahdavi, M., Meidani, M. 2013; 4 (12)

  View details for Web of Science ID 000214124800016

• Recurrent Acute Pancreatitis and Cholangitis in a Patient with Autosomal Dominant Polycystic Kidney Disease INTERNATIONAL JOURNAL OF PREVENTIVE MEDICINE Yazdanpanah, K., Manouchehri, N., Hosseinzadeh, E., Emami, M., Karami, M., Sarrami, A. 2013; 4 (2): 233-236

  Abstract

  Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder associated with multiple cyst formation in the different organs. Development of pancreatic cyst in ADPKD is often asymptomatic and is associated with no complication. A 38-year-old man with ADPKD was presented with six episodes of acute pancreatitis and two episodes of cholangitis in a period of 12 months. Various imaging studies revealed multiple renal, hepatic and pancreatic cysts, mild ectasia of pancreatic duct, dilation of biliary system and absence of biliary stone. He was managed with conservative treatment for each attack. ADPKD should be considered as a potential risk factor for recurrent acute and/or chronic pancreatitis and cholangitis.

  View details for Web of Science ID 000214095900018

  View details for PubMedID 23543834

  View details for PubMedCentralID PMC3604858

• An unusual endoscopic presentation of solitary rectal ulcer syndrome INDIAN JOURNAL OF GASTROENTEROLOGY Yazdanpanah, K., Shavakhi, A., Sanei, M., Pezeshki, A., Sarrami, A. 2013; 32 (1): 58-59

  Abstract

  Solitary rectal ulcer syndrome (SRUS) is an uncommon rectal disorder. Massive rectal bleeding is a rare presentation of SRUS, and can pose an endoscopic challenge in differentiating from other causes of massive rectal bleeding. A 22-year-old man presented with massive rectal bleeding which had SRUS with spurting bleeding on lower endoscopic evaluation. He was treated by endoscopic hemostasis using argon plasma coagulation. He had no complaint after a month and follow up lower endoscopy proved complete healing within two months. SRUS should be considered as a potential cause of massive rectal bleeding.

  View details for DOI 10.1007/s12664-012-0184-2

  View details for Web of Science ID 000210610900011

  View details for PubMedID 22585569

• The necessity of stroke prevention in patients with systemic lupus erythematosus JOURNAL OF RESEARCH IN MEDICAL SCIENCES Saadatnia, M., Sayed-Bonakdar, Z., Mohammad-Sharifi, G., Sarrami, A. 2012; 17 (9): 894-895

  View details for Web of Science ID 000311042900018

  View details for PubMedID 23826023

  View details for PubMedCentralID PMC3697221

• Precise Recognition of Liver Inflammatory Pseudotumor May Prevent an Unnecessary Surgery INTERNATIONAL JOURNAL OF PREVENTIVE MEDICINE Sarrami, A., Baradaran-Mahdavi, M., Meidani, M. 2012; 3 (6): 432-434

  Abstract

  Liver inflammatory pseudotumor (IPT) is considered a benign inflammatory lesion mostly presented as a solitary solid mass in the right hepatic lobe. It may clinically and radiologically mimic a malignant liver tumor or an abscess. Accordingly, diagnoses of most of the reported cases have been established after surgical resection. In this report, we describe a 52-year-old woman with a 1-year history of fever of unknown origin. In the following investigation, abdominal computed tomography (CT) scan showed infiltrative lesion in the right hepatic lobe. The patient underwent a CT-guided needle biopsy of the hepatic lesion. Histopathologic study of biopsy specimen revealed the features of IPT. The patient was discharged and followedup for 6 months. After 6 months she had no complaint of fever and control liver ultrasonography disclosed no lesion. As liver IPT has favorable response to conservative therapy and may also resolve spontaneously, precise recognition of this condition with the help of fine-needle biopsy may help to avoid unnecessary surgery.

  View details for Web of Science ID 000214074100010

  View details for PubMedID 22783471

  View details for PubMedCentralID PMC3389442

• Rapid exacerbation of multiple sclerosis following the initiation of interferon-beta: report of nine cases JOURNAL OF RESEARCH IN MEDICAL SCIENCES Etemadifar, M., Sarrami, A. 2011; 16 (12): 1619-1622

  Abstract

  Interferon-β (IFN-β) is an effective drug in multiple sclerosis (MS) but it may cause acute exacerbation of MS following the initiation of treatment. This study evaluated patients with rapid exacerbation of multiple sclerosis (REMS) following the initiation of IFN-β.We retrospectively reviewed the clinical records of 2350 patients with multiple sclerosis who started treatment with IFN-β and were registered with Isfahan MS Society (IMSS). Patients with rapid exacerbation of multiple sclerosis within 24 hours after initiation of IFN-β treatment were selected and their demographic and clinical data were extracted.We identified nine patients with rapid exacerbation of multiple sclerosis following the initiation of IFN-β. Their mean age at the time of treatment with IFN-β was 37.3 ± 6.28 years. Seven patients had rapid exacerbation of multiple sclerosis after initiation of IFN-β 1a and two patients after IFN-β 1b. The course of disease in all of these patients was relapsing-remitting. However, all had converted into secondary progression within the first year after occurrence of rapid exacerbation of multiple sclerosis following the initiation of IFN-β.This study may indicate that the effects of IFN-β are not purely anti-inflammatory and a small percentage of MS patients experience rapid exacerbation of multiple sclerosis following the initiation of IFN-β. Future studies are needed to validate our findings.

  View details for Web of Science ID 000299585800015

  View details for PubMedID 22973372

  View details for PubMedCentralID PMC3434905

• A case of intracranial malignant fibrous histiocytoma JOURNAL OF RESEARCH IN MEDICAL SCIENCES Sarrami, A., Setareh, M., Afshar-Moghaddam, N., Izadinejad, M., Saadatnia, M. 2011; 16 (7): 968-973

  Abstract

  We describe a case of intracranial malignant fibrous histiocytoma which had infiltrated pons, cerebellum and basal surface of left temporal lobe without any visible mass. The patient presented with a sudden loss of consciousness and vomiting. Clinical findings, laboratory tests, imaging and examination of the cerebrospinal fluid tended to establish the diagnosis of an infectious condition than a malignancy. Without any response to the antibiotics and with a progressive deterioration of neurologic and mental condition, the patient died after 20 days. In the autopsy, histological and immunohistochemical study of the brain revealed the diagnosis of malignant fibrous histiocytoma (MFH).

  View details for Web of Science ID 000295905800018

  View details for PubMedID 22279468

  View details for PubMedCentralID PMC3263113

• Multiple intestinal perforations as a primary manifestation of abdominal tuberculosis in a HIV-infected patient JOURNAL OF SURGICAL CASE REPORTS Sarrami, A., Sharifi, M., Ahsan, M., Afsharmoghaddam, N. 2010: 7

  Abstract

  Abdominal tuberculosis (TB) is the sixth commonest extra-pulmonary TB form after lymphatic, genitourinary, bone and joint, miliary and meningeal tuberculosis. Perforation is a serious and uncommon complication of abdominal tuberculosis which can occur even during the treatment. A 30-year-old man was admitted with a three-day history of abdominal pain who had emergency surgery for multiple perforations of the distal ileum.

  View details for Web of Science ID 000215755000007

  View details for PubMedID 24945844

  View details for PubMedCentralID PMC3649186