Multiple sclerosis (MS) presents with optic neuritis (ON) in 20 % of cases and 50 % of ON patients develop MS within 15 years. In this study, we evaluated the preventive effects of vitamin D3 administration on the conversion of ON to MS (primary outcome) and on the MRI lesions (secondary outcome) of ON patients with low serum 25 (OH) D levels. Thirty ON patients (15 in each of 2 groups, aged 20-40 years) with serum 25 (OH) D levels of less than 30 ng/ml were enrolled in a double blind, randomized, parallel-group trial. The treatment group (cases) received 50,000 IU of vitamin D3 weekly for 12 months and the control group (controls) received a placebo weekly for 12 months. Finally, the subsequent relapse rate and changes in MRI plaques were compared between the two groups. Risk reduction was 68.4 % for the primary outcome in the treatment group (relative risk = 0.316, p = 0.007). After 12 months, patients in the treatment group had a significantly lower incidence rate of cortical, juxtacortical, corpus callosal, new T2, new gadolinium-enhancing lesions and black holes. The mean number of total plaques showed a marginally significant decrease in the group receiving vitamin D3 supplementation as compared with the placebo group (p = 0.092). Administration of vitamin D3 supplements to ON patients with low serum vitamin 25 (OH) D levels may delay the onset of a second clinical attack and the subsequent conversion to MS.

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Background: The pulmonary artery obstruction index (PAOI), which is evaluated by the CT pulmonary angiography, offers an objective method to measure the severity of pulmonary arteries obstruction. Objectives: We decided to investigate the correlation between the PAOI determined by CT pulmonary angiography, as an index to determine the severity of pulmonary embolism (PE), with two clinical models used for predicting the probability of acute PE, namely the Wells criteria and the simplified revised Geneva score. Patients and Methods: Sixty-four consecutive patients with definite diagnosis of acute PE based on CT pulmonary angiography were enrolled. The Wells score as well as simplified revised Geneva score were calculated retrospectively using the medical records. Then, the PAOI was determined by CT pulmonary angiography. By applying the Pearson's correlation coefficient, the relationships were investigated. Results: The Wells score had a weak correlation with the PAOI (r = 0.29; P = 0.01). The simplified revised Geneva score did not have significant correlation with the PAOI (r = 0.1; P = 0.2). Furthermore, patients with active cancer had significantly higher CT indexes than the other patients with PE (P = 0.046). Conclusion: Although the Wells and simplified revised Geneva scores are used widely for assessing clinical probability of PE, these scores may not necessarily correlate with the severity of PE. The Wells score had a weak correlation and may somehow predict the severity of PE. Malignancy is a significant risk factor found to be correlated with more severe PE.

BACKGROUND: Cerebral venous sinus thrombosis (CVST) is a scarce disease with poor prognosis and its diagnosis often challenges physicians due to nonspecific symptoms and widespread clinical manifestations. AIM: To investigate the findings of magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) of patients with CVST diagnosis in Ali Ebne Abitaleb Hospital in Zahedan during 2013–2016 and to evaluate imaging pitfalls involving in late diagnosis, complications, and even death. METHODS: This retrospective descriptive study was done on 57 patients with confirmed CVST during 2013–2016 in Ali Ebne Abitaleb Hospital in Southeast of Iran (Zahedan). The MRI and MRV findings and related diagnostic pitfalls were evaluated. Twenty-one patients are pediatrics and 33 patients are adults. RESULTS: Of 57 patients, evidences of cerebral edema were found in 33 patients, among whom 2 patients showed parenchymal edema (cerebral edema) without infarction, and 31 patients exhibited parenchymal edema with infarction. The frequency of involvement in descending order was as followed; transverse sinus (96.49%), sigmoid sinus (49.12%), superior sagittal sinus (29.82%), jugular vein (19.29%), internal cerebral veins (7.01%), straight sinus (5.2%), and cortical veins (5.2%). Diagnostic pitfalls were also found in 8 patients. Seven patients exhibited acute and subacute thrombosis mimicked normal sinus flow void in T2-weighted images. No filling defect was seen on gadolinium-enhanced T1-weighted image in the other patient due to the sub-acute phase of thrombosis. CONCLUSION: The delayed diagnosis of CVST originating from nonspecific clinical features and diagnostic imaging pitfalls can result in poor outcomes in patients. To prevent the diagnostic pitfalls, the clinician should give a brief history and clinical data and radiologist(s) should interpret the findings in addition to the use of advanced MR sequences.