Current Medical Imaging - Volume 14, Issue 1, 2018

Background: One of the primary causes of tumor death in the world is lung cancer. Lung cancer is caused by abnormalities in the lung called nodules. Different medical imaging techniques are used to detect these nodules, like Chest X-ray, Computed Tomography (CT), etc. Methods: Computer Aided Detection (CAD) in radiology provides a second opinion to radiologists in determining medical abnormalities by providing automated analysis of medical images. A standard lung cancer CAD system consists of five main processing steps: acquisition, pre-processing, lung segmentation, nodule detection and false positive reduction. Results: This paper overviews some of the current state-of-the-art CAD systems and presents the algorithm used for each processing step. Conclusion: It also provides a comparison of the performance of the existing approaches.

Background: Prostate cancer (PCa) is a leading dreadful cancer amid aged men in the United States. During past few decades, a number of studies have been carried out in both medical field and imaging technology for PCa detection and diagnosis. Techniques: Imaging technology-based diagnosis includes TRUS, MRI and CT at the macroscopic level and histological images at the microscopic level. Discussion: To assist novice researchers for a better understanding of prostate segmentation techniques, this article mainly presents the survey of various delineation techniques for prostate pertaining to different modalities i.e. TRUS, MRI and CT, which is an important auxiliary phase in PCa diagnosis. This paper also highlights various PCa grading approaches based on histology imaging with certain gaps that need to address for timely and precise diagnostic recommendations to suppress mortality rates globally. Quantitative/qualitative evaluation and analysis of the existing state-of-the-art segmentation techniques along with their strength and limitations as described in literature is also presented. Conclusion: Prostate delineation is still an open challenge and with progression of technology for identification, medication and follow up of prostate diseases, new prerequisites have to be realized.

Background: High-intensity focused ultrasound ablation is an emerging mode of therapy for benign and malignant neoplastic processes; with respect to musculoskeletal tumors, high-intensity focused ultrasound ablation has been used for palliative treatment of bone metastases and primary treatment of osteoid osteoma, synovial sarcoma, osteosarcoma, Ewing sarcoma, chondrosarcoma and giant cell bone cancer. However, very little has been reported on its use on soft tissue tumors including extra-abdominal desmoids. Objective: We provide an overview of studies assessing the efficacy of high-intensity focused ultrasound ablation for extra-abdominal desmoids and its potential future applications. Methods: A review of the literature was conducted using the keywords “desmoid” and “focused ultrasound”; articles, which provided interpretable data about the treatment of this pathological condition using high-intensity focused ultrasound, were identified. Results: Experience with high-intensity focused ultrasound ablation of extra-abdominal desmoids is limited and in particular it has been reported by Wang et al. in 2011 and by Avedian et al. in 2015. According to these research groups, high-intensity focused ultrasound is a safe and effective non-invasive therapeutic modality in the treatment of desmoid tumors. Conclusion: High-intensity focused ultrasound may be useful to treat soft tissue tumors of extremities, especially in situations in which standard treatments would be associated with unacceptable morbidity as is often the case with extra-abdominal desmoids.

Background: Obesity studies involving animal models require a method for adipose tissue (AT) amount assessment. This paper focuses on the application of clinical computed tomography (CT) for abdominal obesity assessment in rats as an alternative to dedicated microtomographic systems. Additionally, the authors propose L1-L6 instead of L1-L5 region of interest (ROI) usually used for the intra-abdominal adipose tissue (IAAT) assessment and they check if the applied X-ray energy influences results. Methods: 16 Wistar rats with different body mass (BM) were involved in the study. The animals were scanned by CT to achieve three-dimensional images which were subsequently analyzed for AT amount. AT was identified on the basis of fixed Hounsfield unit scale. Two X-ray tube voltages were tested: 80 kVp and 120 kVp. The results were compared to the fat pads mass (FPM) extracted after animal sacrifice. FPM was also correlated to BM. Result: The correlation between FPM and BM was statistically non-significant (r=0.3131, p=0.2376). AT amounts obtained for different CT X-ray tube voltages (80 kVp vs. 120 kVp) were practically the same (r=0.9996, p<0.001). There was significant correlation between FPM and AT mass based on CT images, regardless of the ROI choice. Correlation coefficients amount to r=0.932, p<0.001 and 0.945, p<0.001 for L1-L6 and L1-L5, respectively. Conclusion: BM is not a good descriptor of abdominal obesity. The X-ray beam energy and the choice of ROI do not influence the results considerably. CT allows for fast and reliable IAAT amount assessment in rats.

Introduction: Vincristine sulphate is an antineoplastic agent, used in combination for the chemotherapyof B-cell neoplasm and acute lymphoblastic leukemia. Our aim was to label the vincristine with 99mTc and study it's in vivo localization in animal model, so that in future we utilize it as potential imaging agent of colon. Materials and Methods: 2mg of vincristine using stannous chloride was labeled with ^99mTcO4. Its radiochemical purity was checked by instant layer chromatography using TLC/SG as a stationary phase and methanol: (diethyl-amine: water=1:9): 70:30and found 98.7% as complex. The time based study from 10 to 240 min. wasdone by acquiring anterior and posterior static images. Results: Organ versus blood Region of Interest (ROI) was drawn and time-activity graph was plotted. It was found that after 10min. 20.8% of total activity was localized in lungs, metabolized by liver, and excreted through gut. After 120 minutes, 29.3% of labeled drug was localized in colon and was execrated through gut. Its localization in lungs, retention in colon showed that it follows the same path as therapeutic vincristine sulphate. Conclusion: It was concluded that vincristine formed a stable complex with 99mTc, which can be used in further studies as an imaging agent of colon.

Background: The lossy compression algorithm produces different results in various contrasts areas. Low contrast area image quality declines greater than that of high contrast regions using equal compression ratio. These results were obtained in a subjective study. The objective image quality metrics are more effective if the calculation method is more closely related to the human vision results. Methods: This study first measured the PSNR and MI for discrimination between different contrast areas responding to lossy image compression in a SMPTE electronic pattern. The MI was consistent with human vision results in SMPTE electronic phantom but PSNR was not. The measurement was also applied to compressed medical images in different contrast cropping regions. Results: The MI was found to be close to human vision in CT and MR but not CRX. Both weighted PSNR and weighted MI were created to respond to the gray value and the contrast areas affected the quality estimation. Conclusion: The W-PSNR and W-MI showed that they can discriminate between different contrast areas using image compression ratios and the series of lines are equal to the contrast values and better than the tranditional approach. The W-MI measures were found to perform better than WPSNR and can be used as an image quality index.

Background: Periodically assessment of the healing process of diabetic wound is a very important task for clinicians. The quantitative analysis of wound is useful to monitor and evaluate the healing process with the intervention of drug therapies. Currently, the evaluation process focuses mainly on visual inspection, which is not accurate enough to accomplish the task. Methods: Segmentation and detection of region of the wound in tissues is an emerging field for assessing the healing process. This paper presents the supervised learning methods to detect and classify the type of wound tissues. Fast Fuzzy C-means and K-means clustering algorithms has been implemented for classifying and detecting the boundary of wounds and also the size of the wound has been measured from images. Results: The intensity of the images has been normalized, and wounds were segmented in five images collected from the open source database. The output result shows that the boundary of the wound has been extracted accurately by both the methods. The enhanced Fast Fuzzy C-means provides better visual segmented output compared K-means process in terms of high PSNR and low MSE values. The high PSNR of 55.57 is measured in EnFuzzy C-means compared to K-means algorithm with a value of 54.74 and the effectiveness of the process has also been calculated by integrating both the process. Conclusion: These methods may be useful in accessing and analyzing the wound healing process in qualitative and quantitative manner in diabetic cases.

Background: The second chief foundation of enduring visual deficiency around the world is Glaucoma. Timely exposure of this disease can confine the advancement in disease progression. Calculating Cup to Disk Ratio is amongst the effective ways for figuring out the presence of glaucoma. Methods and Materials: In this paper, a Cup to Disk Ratio and Rim to Disk Ratio calculation based glaucoma detection method is proposed. The proposed technique comprises of three main phases. In the preliminary stage, the image is preprocessed and optic disk is segmented out using Fourier Transform, Active Contour and Circular Hough Transform followed by ocular cup segmentation stage. Ocular cup segmentation is carried out through morphological operations, Circular Hough Transform, Median Filter and Active Contour Segmentation algorithms. The outcomes of proposed technique are tested on 200 images taken from four different databases including comparison with the results of approaches proposed and implemented in the prospect of ocular cup and optic papilla based segmentation. Results & Conclusion: The results achieved through the proposed technique showed that the proposed strategy acquired high exactness in the segmentation of optic papilla and ocular cup hence obtained RDR and CDR values near the clinical CDR values.

Background: In the last few years, the number of patients suffering from Alzheimer disease has rapidly increased. This illness is a brain disease which begins at the hippocampus. Then, it spreads to the rest of the brain. It attacks especially people over the age of 65. Thus, it is necessary to develop methods to facilitate its early detection. Methods: As part of this thesis, we tried to compare two methods of classification; the method of k Nearest Neighbor (KNN) and Support Vector Machine (SVM) to make the diagnosis of Alzheimer. The first step consists in segmenting the images into distinct blocks. After that, a features extraction is applied only on the part containing the hippocampus of the brain. Result: The following step is the classification. It allows us to know the patient's condition. Conclusion: We assess the two classifiers on the Oasis image base. The obtained results show that the KNN method is more efficient than the SVM approach.

Background: Multiple Sclerosis (MS) is a chronic multifactorial disease of the central nervous system, specifically characterized by inflammatory demyelination and primary neurodegeneration. Recently, a possible role for the TARDBP Ala382Thr mutation in inducing neurodegeneration in MS has been hypothesized, considering its confirmed role in other neurodegenerative diseases. The aim of the present study was to explore if this mutation plays a role in inducing or enhancing the brain atrophy in MS. Methods: The study included a group of MS patients carrying the TARDBP Ala382Thr mutation, genetically tested at the MS Centre of the University of Cagliari. Mutated MS patients were age, sex, disease course and EDSS-matched with MS patients without mutation, randomly selected from the genetic database. Recruited patients underwent a brain MRI with a 1.5 Tesla Siemens scanner. Volumes of Whole Brain (WB),White Matter (WM) and Grey Matter (GM) were estimated with SIENAX. The difference in brain volumes was assessed with independent samples t-test. Results: Lower WM volumes resulted significantly associated to mutated group (688.68 ml ± 36.55 vs. 713,22 ml ± 27.34; p 0.03). No difference in WB and GM volumes was reported between the two groups. Discussion and Conclusion: Despite this mutation does not play a major role in MS pathogenesis, it may contribute in enhancing the brain atrophy, especially for WM. However, additional studies in other MS populations are needed to better know this issue.

Background: Foramen of Huschke is anatomical anomaly in the antero-inferior aspect of external auditory canal (EAC), and is associated with pathologies. Awareness about this anomaly is clinically important. Objective: The aim of this study is to document the prevalence, laterality, and dimensions of the foramen of Huschke in the Iranian population. Methods: We retrospectively evaluated 246 cone bean computed tomography (CBCT) imaging studies of temporal bone bilaterally in patients 10 to 65 years old. Scans were studied in axial, sagittal and coronal planes. We inspected the bony dehiscence of the antero-inferior aspect of EAC. We checked for the presence of the foramen, size, laterality, prevalence, and distribution in males and females. Results: The foramen of Huschke was observed in 41 of 246 patients (7 males, 34 females). The foramen was found to be unilateral in 31 patients and bilateral in 10 cases. There was significant difference in the prevalence between women and men (p=0.004). Conclusion: Considering its clinical importance, the foramen of Huschke is not an unusual anomaly and can be easily identified in CBCT images.

Facet joint tropism is defined as asymmetry in the facet joint angles, where one joint has a more coronal orientation than the other. Facet joint tropism is currently a subject of intense interest because it has the potential to markedly alter the motion patterns of the lumbar spine and ultimately contribute to low back pain. Objective: The aim of the study was to find out the frequency of facet tropism in the adult lumbar spine. Methods: Lumbar spines from 20 cadavers of adults (18 males and 2 females) aged between 20 and 45 years were dissected. The angle of facet orientation was measured at every level using the technique of Cyron and Hutton. Similarly, available CT scans of thirty six adults between the ages of 20 and 45 years (mean 30 years) were subjected to evaluation of the lumbar spine. The facet angles were measured using digitiser and AutoCAD software. Results: This study showed that the facet tropism occurs frequently in the lumbar spine in general population especially at L4-L5, L5-S1 and L2-L3 levels. There was also a relatively high incidence of facet asymmetry at L2-L3 level in both the cadaveric and the CT Scan study. Conclusion: Facet asymmetry is common at L4-L5, L5-S1 and L2-L3 levels. Advances in Knowledge: Since the lower two lumbar levels are the most mobile segments of the lumbar spine, it is possible that any abnormal geometry of the facet joints could play a part in the pathogenesis of lumbar spinal instability and disc degeneration at these levels.

Background: Lung cancer is one of the leading causes of cancer-related deaths. Computer- aided diagnosis systems facilitate the radiologists in early diagnosis of pulmonary nodules. It improves the performance of the diagnostic process by providing the second opinion. Methods: A lung nodule detection method which consists of multiple steps has been proposed. At first step lung region is separated using the optimum multi-thresholding method. For smoothing the boundaries and filling the holes, morphological operations are used. In the next step, nodule candidates are extracted using polygon approximation. Further, features of nodule candidates are extracted, and a hybrid feature vector is created using Histograms of Oriented Gradients, intensity and geometric features from enhanced nodule candidates, supported by Contrast Limited Adaptive Histogram Equalization. On the basis of selected feature vectors, Support Vector Machine has been used for classification. Conclusion: The proposed system is evaluated over a standard dataset of Lung Image Consortium Database (LIDC) and achieved an accuracy of 98.8%, sensitivity 97.7%, specificity 96.2% and very low false positive rate of 3.8. It will provide valuable assistance to the radiologists in the diagnostic process.

Background: 128-Multi-detector computerized tomography (128-MDCT) technologies make the detection of inferior phrenic arteries (IPAs) originations and traces possible. Knowing their originating and variations is very important for planning interventional and surgical procedures. Objective: To evaluate the IPAs variations in a large patient group, using 128-MDCTA. Methods: The origin, trace and branching pattern of IPAs were evaluated using128- MDCTA in 1029 patients. The study population included 53.3% males and 46.7% females with a mean age of 59±15.7 years. We used abdominal aortic CTA and hepatic arterial phase images of triphasic abdominal CT which were obtained for various reasons. Results: Right and left IPA (RIPA and LIPA) arose from the celiac trunk (35,6% and 46,6%), abdominal aorta (27,2% and 23,4%), right and left renal artery (8,6% and 0,9%), and left gastric artery (1,1% and 0,9 %). Respectively IPAs rarely originate from accessory or polar renal artery, main hepatic artery, superior mesenteric artery (SMA), splenic artery, dorsal pancreatic artery and accessory left hepatic artery. In 74% of the patients RIPA and LIPA originated from a separate branch, whereas in 26% of the patients RIPA and LIPA originated from a common trunk. The localization of common trunk was celiac trunk in 13,6%, abdominal aorta in 11,4%, left gastric and right renal artery in 0,3%, left renal artery in 0,2% and splenic artery in 0,1% of the patients. Conclusion: This study is the first to detect 9 new origin sites and 4 new common root types of IPAs.

Objective: To investigate the relationship between left or right cubital veins as intravenous contrast injection sites and the quality of enhanced CT thorax images. Materials and Methods: 332 consecutive patients who underwent contrast enhanced MDCT thorax were included. Subjects were divided into three age groups: Group 1 - <40 years, group 2 - 40-60 years, and group 3 - >60 years, who were administered contrast injection into either left or right cubital veins based on stratified randomization. Anteroposterior distance (APD) is defined as the distance between posterior border of manubrium and anterior border of aortic arch or brachiocephalic artery, where left brachiocephalic vein traverses, which was measured and compared against image quality. Results: Contrast enhanced images obtained with injection into the right cubital vein showed better quality than those obtained with injection through the left (P < 0. 05). APD showed a statistically significant difference between group 1 and group 3. No significant difference was found between group 1 and 2, and between group 2 and 3. APD correlated with image quality of scans obtained with injection on left cubital vein (P < 0. 05). Conclusion: Better contrast enhanced CT thorax image quality was seen with injection into right cubital vein by avoiding passage through possibly compressed left brachiocephalic vein, especially in older patients.

Background: Obstructive uropathy is a common public health issue that requires imaging research for providing necessary information. The data is important for determining treatment options, and may influence selective management choices. Objective: The aim of the study is to determine whether magnetic resonance urography or computerized tomography urography is the best imaging modality among patients with suspected obstructive uropathy. Methods: Seventy patients; referred from the emergency department for the evaluation of renal colic or hematuria that highly suggested urinary tract abnormalities, were prospectively enrolled. Thirty five women and 35 men were categorized with a mean age of 43.52 years and the mean body weight of 61.31 kg. All participants underwent abdominal ultrasonography and clinical examination to detect the causes of urinary obstruction. Pregnant women were excluded from the study. Both magnetic resonance urography and computerized tomography urography were performed within 30 days of each analysis. Results: Only 54.3% of the participants had urinary stones. Mean size of the renal stone was 11 mm; while mean size of the ureteral stone was 3.8 mm. The approach of magnetic resonance is not only limited to diagnosis, but is also effectively involved in the real time investigations. MRU has more reliability in terms of the diagnosis and anatomic presentation of the kidneys along with the vasculature. All cases of urinary stones were detected by computed tomography (100%); whereas, 78.9% cases were detected by magnetic resonance urography. Conclusion: Computerized tomography urography is more sensitive in detecting kidney stones; whereas, magnetic resonance urography is better in detecting pathology behind the development of kidney stones.

Background: Fetal echocardiography is an important method in prenatal diagnosis of Congenital Heart Disease (CHD). Fetal cardiac axis can be used as a reliable parameter in the diagnosis of CHD. The objective of this study was to discuss the abnormal fetal cardiac axis in the diagnostic value of fetal congenital heart disease. Methods: In a 3-year period, 296 women with 20 and 40 weeks' singleton gestations referred for perinatal ultrasound consultation underwent evaluation of the fetal cardiac axis. For measurement of fetal cardiac axis, the chest axial image was obtained at the level of the four-chamber view. Of the 296 pregnancies, 260 healthy pregnancies were categorized as Group A while 36 pregnancies with severe heart disease were Group B. Cardiac anomaly was confirmed either by neonatal echocardiography or autopsy. Results: Cardiac anomaly has been found in 36 women, 24 had abnormal axis (three with axis smaller than normal; 21 with axis larger than normal). The mean of cardiac axis for Group A (38.1±7.6°) was significantly smaller than that of Group B (52.6±19.8°) (P<0.001). The cardiac axis was independent from gestational age. With two standard deviations above and below the mean of Group A as normal cardiac axis (22.9°-53.5°), abnormal fetuses were defined as having axis < 23° or > 54°. There were 6 cases (2.3%) of cardiac axis larger than normal and no case (0%) smaller in group A, and 21 cases (58.3%) larger and 3 cases (8.3%) smaller in group B. The difference in two groups of patients with abnormal cardiac axis was statistically significant (P<0.01). The incidence of abnormal cardiac axis of group A was less than group B. Conclusions: The measurement of fetal cardiac axis is simple and effective. Any larger or smaller fetal cardiac axis than normal is suggestive of a cardiac anomaly and requires further investigation. Four-chamber view is an important plane of fetal echocardiography.

The following article has been withdrawn at the request of the authors and editor of the journal Current Medical Imaging Reviews: Title: The Clinical Value of Prenatal 3D Ultrasonic Diagnosis on Fetus Hemivertebra Deformity- A Preliminary Study; Current Medical Imaging Reviews, vol. 14, no. 1; Pp. 139 - 142 Authors: Yanting Wen, Guishuang Xiang, Xiaoqiu Liang, Xiaoqian Tong. Bentham Science apologizes to the readers of the journal for any inconvenience this may cause. Bentham Science Disclaimer: It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Furthermore, any data, illustration, structure or table that has been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submitting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors, if plagiarism or fabricated information is discovered. By submitting a manuscript the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.