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- Volume 19, Issue 8, 2023
Current Medical Imaging - Volume 19, Issue 8, 2023
Volume 19, Issue 8, 2023
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Artificial Intelligence in Breast Imaging: A Special Focus on Advances in Digital Mammography & Digital Breast Tomosynthesis
Breast cancer accounts for 30% of female cancers and is the second leading cause of cancerrelated deaths in women. The rate is rising at 0.4% per year. Early detection is crucial to improve treatment efficacy and overall survival of women diagnosed with breast cancer. Digital Mammography and Digital Breast Tomosynthesis have widely demonstrated their role as a screening tool. However, screening mammography is limited by radiologist’s experience, unnecessarily high recalls, overdiagnosis, overtreatment and, in the case of Digital Breast Tomosynthesis, long reporting time. This is compounded by an increasing shortage of manpower and resources issue, especially among breast imaging specialists. Recent advances in image analysis with the use of artificial intelligence (AI) in breast imaging have the potential to overcome some of these needs and address the clinical challenges in cancer detection, assessment of treatment response, and monitoring disease progression. /p>p> This article focuses on the most important clinical implication and future application of AI in the field of digital mammography and digital breast tomosynthesis, providing the readers with a comprehensive overview of AI impact in cancer detection, diagnosis, reduction of workload and breast cancer risk stratification.
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FDG PET/CT Volume-Based Quantitative Data and Survival Analysis in Breast Cancer Patients: A Systematic Review of the Literature
Purpose: The study aims to assess the role of SUVs, MTV, TLG, and other FDG PET metric data in predicting the prognosis of patients with newly diagnosed BC. Materials and Methods: A systematic review was conducted by using three different databases: Pub- Med, Web of Science, and EMBASE, in the period between January 2011 and May 2021. Studies on the use of FDG PET in BC patients concerning the utility of metric PET data and survival were retrieved. The following keywords were used in diverse combinations: “breast cancer”, “18F-FDG”, “FDG”, “PET”, “PET/CT”, “FDG PET”, “volumetric parameters”, “metabolic tumor volume”, “MTV”, “total lesion glycolysis”, “TLG”, “prognosis”, “prognostic”. No limits were applied. The quality of selected papers was assessed by using specific criteria. Results: Totally 123 articles were retrieved, but only 14 studies were selected. In the selected papers, overall, the number of patients was 1850. Overall survival (OS) was the main outcome in three studies, while both OS and disease-free survival (DFS) were considered in the remainder of most papers. PET/CT was performed in patients with BC before surgery or neoadjuvant chemotherapy in 6 studies and in metastatic BC in 8. At multivariable analyses, diverse PET metrics, such as SUVmax, MTV, and TLG, were correlated to recurrence or OS. However, a large heterogeneity for the proposal cut-off, able to discriminate between poor and good prognosis, was found. Conclusion: PET metrics are helpful for the prognosis stratification in patients with locally advanced or metastatic BC. However, no specific cut-off values for these variables are now available in this setting of patients.
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The Role of Theragnostics in Breast Cancer: A Systematic Review of the Last 12 Years
Background: Breast cancer is the most common malignancy in women, with high morbidity and mortality. Molecular alterations in breast cancer involve the expression or upregulation of various molecular targets that can be used for diagnostic nuclear medicine imaging and radiopharmaceutical treatment. Theragnostics is based on the binding of radionuclides to molecular targets. These radionuclides can induce a cytotoxic effect on the specific tumor cell (target) or its vicinity, thus allowing a personalized approach to patients with effective treatment and comparably small side effects. Aim: This review aims to describe the most promising molecular targets currently under investigation for theragnostics and precision oncology in breast cancer. Methods: A comprehensive literature search of studies on theragnostics in breast cancer was performed in the PubMed, PMC, Scopus, Google Scholar, Embase, Web of Science, and Cochrane library databases, between 2010 and 2022, using the following terms: breast neoplasm*, breast, breast cancer*, theragnostic*, theranostic*, radioligand therap*, RLT, MET, FLT, FMISO, FES, estradiol, trastuzumab, PD-L1, PSMA, FAPI, FACBC, fluciclovine, FAZA, GRPR, DOTATOC, DOTATATE, CXC4, endoglin, gastrin, mucin1, and syndecan1. Results: Fifty-three studies were included in the systematic review and summarized in six clinical sections: 1) human epidermal growth factor receptor 2 (HER2); 2) somatostatin receptors (SSTRS); 3) prostate-specific membrane antigen radiotracers (PSMA); 4) fibroblast activation protein-α targeted radiotracers; 5) gastrin-releasing peptide receptor-targeted radiotracers; 6) other radiotracers for theragnostics. Conclusion: The theragnostic approach will progressively allow better patient selection, and improve the prediction of response and toxicity, avoiding unnecessary and costly treatment.
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Artificial Intelligence in Breast Cancer: A Systematic Review on PET Imaging Clinical Applications
Background: 18F-FDG PET/CT imaging represents the most important functional imaging method in oncology. European Society of Medical Oncology and the National Comprehensive Cancer Network guidelines defined a crucial role of 18F-FDG PET/CT imaging for local/locally advanced breast cancer. The application of artificial intelligence on PET images might potentially contributes in the field of precision medicine. Objective: This review aims to summarize the clinical indications and limitations of PET imaging for comprehensive artificial intelligence in relation to breast cancer subtype, hormone receptor status, proliferation rate, and lymphonodal (LN)/distant metastatic spread, based on recent literature. Methods: A literature search of the Pubmed/Scopus/Google Scholar/Cochrane/EMBASE databases was carried out, searching for articles on the use of artificial intelligence and PET in breast tumors. The search was updated from January 2010 to October 2021 and was limited to original articles published in English and about humans. A combination of the search terms "artificial intelligence", “breast cancer”, “breast tumor”, “PET”, “Positron emission tomography”, “PET/CT”, “PET/MRI”, “radiomic”," texture analysis", “machine learning”, “deep learning” was used. Results: Twenty-three articles were selected following the PRISMA criteria from 139 records obtained from the Pubmed/Scopus/Google Scholar/Cochrane/EMBASE databases according to our research strategy. The QUADAS of 30 full-text articles assessed reported seven articles that were excluded for not being relevant to population and outcomes and/or for lower level of evidence. The majority of papers were at low risk of bias and applicability. The articles were divided per topic, such as the value of PET in the staging and re-staging of breast cancer patients, including new radiopharmaceuticals and simultaneous PET/MRI. Conclusion: Despite the current role of AI in this field remains still undefined, several applications for PET/CT imaging are under development, with some preliminary interesting results particularly focused on the staging phase that might be clinically translated after further validation studies.
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Review on Deep Learning Methodologies in Medical Image Restoration and Segmentation
Authors: R. Hephzibah, Hepzibah C. Anandharaj, G. Kowsalya, R. Jayanthi and D. Abraham ChandyThis paper comprehensively reviews two major image processing tasks, such as restoration and segmentation in the medical field, from a deep learning perspective. These processes are essential because restoration removes noise and segmentation extracts the specific region of interest of an image, both of which are necessary for accurate diagnosis and therapy. This paper mainly focuses on deep learning techniques. It plays a prominent role over other conventional techniques in handling a large number of datasets in the medical field and provides accurate results. This paper reviewed the application of different convolutional neural network architectures in the restoration and segmentation processes. Based on the results in the case of image restoration, TLR-CNN and Stat-CNN are promising in achieving better PSNR, noise suppression, artifact suppression and improving the overall image quality. For the segmentation process, LCP net achieves the Dice score of 98.12% and sensitivity of 98.95% in the cell contour segmentation; the 3D FCNN model is found to be the best method for the segmentation of brain tumors. This review shows that deep learning methodologies can be a better alternative for medical image restoration and segmentation tasks, as data size is an important concern today.
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Three Class Classification of Alzheimer’s Disease Using Deep Neural Networks
Authors: Deep R. Shah, Rupal A. Kapdi, Jigna S. Patel and Jitali PatelAlzheimer’s disease (AD) is a prevalent type of dementia that can cause neurological brain disorders, poor decision making, impaired memory, mood swings, unstable emotions, and personality change. Deep neural networks are proficient in classifying Alzheimer's disease based on MRI images. This classification assists human experts in diagnosing AD and predicts its future progression. The paper proposes various Deep Neural Networks (DNN) for early AD detection to save cost and time for doctors, radiologists, and caregivers. A 3330-image-based Kaggle dataset is used to train the DNN, including 52 images of AD, 717 images of Mild Cognitive Impairment (MCI), and the remaining images of Cognitive Normal (CN). Stratified partitioning splits the dataset into 80% and 20% proportions for training and validation datasets. Proposed models include DenseNet169, DenseNet201, and Res- Net152 DNNs with additional three fully-connected layers and softmax and Kullback Leibler Divergence (KLD) loss function. These models are trained considering pre-trained, partially pre-trained, and fully re-trained extended base models. The KLD loss function reduces the error and increases accuracy for all models. The partially pre-trained DenseNet201 model outperformed all the other models. DenseNet201 gives the highest accuracy of 99.98% for training, 99.07% for validation, and 95.66% for test datasets. The DenseNet201 model has the highest accuracy in comparison to other state-of-artmethods.
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Activation of Brain Regions Associated with Working Memory and Inhibitory Control in Patients with Attention-Deficit/Hyperactivity Disorder in Functional Near-Infrared Spectroscopy: A Systematic Review
Authors: Lihao Hou, Jiaxuan Yang, Lin Xu, Juanjuan Peng, Cho Y. Joyce Law and Tianhao ChenIntroduction: Patients with attention-deficit/hyperactivity disorder (ADHD) often show abnormalities related to cognitive activities, especially related to working memory and inhibitory control. Functional near-infrared spectroscopy (fNIRS) is a non-invasive brain imaging technique based on the changes in cerebral hemodynamics to measure the response of brain activities to cognitive tasks. Methods: In this review, we collected all clinical experiments that evaluated the changes of oxyhemoglobin levels in relevant brain regions of patients with ADHD through cognitive tasks by fNIRS to determine the abnormalities of brain regions related to working memory and inhibitory control activities in patients with ADHD. Results: From the beginning of November 2021, PubMed, PsycINFO, Scopus, EMBASE, CINAHL, web of science and Cochrane library were searched, and ROBINS-I was a tool to evaluate the quality and risk bias of the articles included. Sixteen eligible clinical trials or randomized controlled trials were included, of which six measured working memory and eleven measured inhibitory control. Conclusion: We found that compared with healthy people, the activation scope of working memory and inhibition control in the frontal cortex in ADHD patients was smaller than that in healthy people, and the activation degree was weak or even inactive, which can provide new ideas for the direction of research on ADHD.
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Literature Review of Automated Grading Systems Utilizing MRI for Neuroforaminal Stenosis
Authors: Asifa Laulloo, James Meacock, Stuart Currie, Joanna Leng and Simon ThomsonBackground: Cervical neural foraminal stenosis is a common and debilitating condition affecting people between the ages 40-60. Although it is established that MRI is the best method of scanning the neural foramen, the question remains whether there is a role for three-dimensional MRIs and whether it is possible to develop a computer-aided automated grading system to establish the degree of clinically relevant cervical foraminal stenosis. Objective: The study's objective is to conduct a literature review of existing or recently developed automated grading systems for the cervical neural foramen, including volumetric MRI evaluations of the foramen. Methods: A systematic search of Cochrane Library, Cochrane Clinical Trials, Ovid MEDLINE, EMBASE, CINAHL, ACM Digital Library and Institute of Electrical and Electronics Engineers (IEEE), and Web of Science was performed for reports examining automated systems and volumetric scanning foraminal stenosis published before 31.07.2021. Results: 3971 articles were identified of which 8 were included in the study. The automated grading systems of the neural foramen focus largely on the lumbar spine with elements that may be applicable to the cervical spine. Although there are established studies on the automated grading of the lumbar spine, it is uncertain whether any of these are reproducible in the cervical spine. Visual grading systems for the cervical spine demonstrate good inter-reader reliability between radiologists and clinicians. Conclusion: The Park visual grading method shows strong inter-reader reliability across radiologists and clinicians despite the limited data on the correlation with neurological symptoms or surgical outcome. There is scope for further development of an automated grading system for cervical foraminal stenosis to improve the speed and consistency of image interpretation.
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Magnetic Resonance Imaging Features and Misdiagnosis of Spinal Epidural Cavernous Hemangioma
Authors: Meng Zhang, Meng-Qiang Xiao, Jing-Zhi Ye, Hong-Yi Li, Pei-Kai Huang, Jun Chen and Jing-Feng LiuObjective: Spinal epidural cavernous hemangiomas (SECHs) are rare, and merely a few have previously been described in case reports. The present study aims to explore the magnetic resonance imaging (MRI) features of SECHs and analyze the causes of their preoperative misdiagnosis. Methods: The present retrospective study included 11 patients (three male and eight female patients, mean age ± standard deviation: 47.55±17.39 years old) with histopathologically confirmed SECH between January 2015 and April 2021. The MRI features of SECH were analyzed by two radiologists. Results: The cervical, thoracic and thoracolumbar segments were involved in 2, 7 and 2 patients, respectively. All lesions grew along the long axis of the spine. The tumors were shuttle-shaped in six patients, oval in two patients, pseudopodia-shaped in one patient, clamp-shaped in one patient, and growing outward along the intervertebral foramen in one patient. Nine SECHs had relatively uniform isointense or hypointense T1-weighted imaging (T1WI) and hyperintense T2-weighted imaging (T2WI) signals. On the T2WI, filamentary low-signal shadows (i.e., the hairline or grid sign) with significant contrast enhancement and asymptotic strengthening were observed. Two SECHs had mixed high and low signals on T1WI and T2WI, with significant heterogeneous enhancement, hemorrhage, and hemosiderin deposition. The SECH was misdiagnosed as meningioma, neurofibromatosis and schwannoma in 1, 1 and 4 patients, respectively, while this was not diagnosed in one patient. The preoperative diagnosis was correct in merely approximately 36% of patients. Among the four patients with a correct preoperative diagnosis, hemosiderin deposition was found in three patients and small tortuous vascular shadows were found in one patient. Conclusion: SECH presents as a long spindle-shaped mass, and the “'pen cap sign” is common at the lesion edges. SECH also exhibits a hairline or grid sign on T2WI. Furthermore, some lesions present with hemorrhage and hemosiderin deposition. Therefore, the hairline, grid sign and hemosiderin deposition are valuable diagnostic features of SECH.
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Humeral Greater Tuberosity Size Measurement at CT Multiplanar Reconstruction
Authors: Zhiyao Li, Lifeng Ma, Wei Yin, Yingjie Wu, Zhengrong Qi, Bo Yang, Jingxin Zhang, Qiang Li and Ai GuoBackground: This study was designed to explore the precise size of the greater tuberosity of humerus in the Chinese population. Methods: The radiologic study was performed on 66 computer tomography (CT) of the shoulder from the CTs hospital’s scan database of the out-patient department from December 2018 to February 2020, including 26 women and 40 men with a mean age of 36.79 ± 9.17 years, with 41 right and 25 left shoulders. The width, height and thickness of the greater tuberosity were measured on CT image multiplanar reconstructions (MPR), which was independently conducted by two observers. Results: The average width was 31.39±2.74 (25.65-36.85) mm. The average height was 27.11±2.57 (21.05-33.50) mm. The average thickness was 11.45±1.18 (9.15-14.30) mm. The average proximal humerus (PH) thickness was 48.98±3.53 (41.40-55.20) mm. There were no significant differences in greater tuberosity (GT) width, GT height, GT thickness and PH thickness between the two observers. The total PH thickness was 51.06±2.30 (45.70-55.20) mm and 45.79±2.57 (41.40-51.25) mm for male and female cases. Gender has a significant impact on the results, men had a larger GT than women. Conclusion: We got the precise size of the humeral greater tuberosity. These data provided important information for further research and clinical practice. The measuring the greater tuberosity with CT image MPR has good reliability.
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Chest CT Features of Patients with COVID-19 Pneumonia Following Hospital Discharge
Authors: Dong Liu, Fangfang Fu, Aihua Ye, Zhenguo Qiao and Chunhong HuObjective: To evaluate chest computed tomographic (CT) findings in patients with coronavirus disease 2019 (COVID-19) pneumonia following hospital discharge. Methods: 52 patients with confirmed COVID-19 pneumonia underwent follow-up chest CT. The scans were obtained on average 43.1 days after hospital admission and analyzed for parenchymal abnormality (e.g., ground-glass opacities, consolidation, or interstitial thickening) and evidence of fibrosis (e.g., assigned to one of three groups: Group 1 (normal lung), Group 2 (parenchymal abnormality but without evidence of fibrosis), and Group 3 (evidence of fibrosis)). Clinical data and CT manifestations of the patients were compared among the three groups. Results: 30.8% (16/52) of patients with COVID-19 pneumonia showed normal lung and were designated as Group 1. 69.2% (36/52) of patients showed parenchymal abnormality ranging from residual ground-glass opacities, consolidation, or interstitial thickening in Group 2 (51.9%) to fibrosis in Group 3 (17.3%). All patients in Group3 had severe/critical COVID-19, while most patients in Group 2 and Group 1 had common COVID-19. Patients in Group 3 were older (60.9 vs. 40.8 and 36.8 years, p<0.001, there is a significant difference), had a longer hospitalization day (20.2 vs. 15.3 and 12.3 days, p<0.05, there is a significant difference), a higher ratio of patients with comorbidities (88.9%vs14.8% and 25%, p<0.001, there is a significant difference), and higher peak CT scores (13 vs. 6.2 and 3.2, p<0.001, there is a significant difference) than those patients in Group 2 and Group 1. Conclusions: Elderly severe/critical COVID-19 patients with comorbidities are more prone to develop fibrosis early on following hospital discharge. On the other hand, lung inflammation in younger patients with common COVID-19 can be resolved completely.
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Cone Beam CT Features and Oral Radiologist’s Decision-making of Arrested Pneumatization of the Sphenoid Sinus
Authors: Noura Alsufyani, Nouf Alsuayri and Raghad AlrasheedObjectives: To assess the demographic and radiographic features of arrested pneumatization of the sphenoid sinus (APS) and their influence on the confidence of oral and maxillofacial radiologists (OMFRs) in diagnosing APS. Methods: Reports of cone beam computed tomography (CBCT) APS were retrieved, and the demographic and radiographic features were retrospectively analyzed. Five OMFRs assessed the CBCT images and their confidence in diagnosing APS. The OMFRs’ experience (years), expertise (skull-base CBCT cases/month) and diagnostic confidence level were analyzed for agreement and associations with demographic or radiographic features. ; Results: Of 29 APS cases, 17 (58.6%) were females, and the mean age was 29.9±19 years. Twenty cases (69.0%) presented unilaterally, and 27 (93.1%) involved the sphenoid body. The most common accessory site was the pterygoid process (19, 65.5%). The vidian canal and foramen rotundum were involved in 27 (93.1%) and 17 (58.6%) cases, respectively. Most cases (28, 96.6%) were well-defined, corticated, and showed mixed attenuation. APS diagnostic confidence was higher among the expert OMFRs (72.4%-82.8% vs. 58.6%-62.1%). Conclusion: Radiographic features differentiating APS from skull-base tumors were shown on CBCT. The confidence of OMFRs with similar experience in years depended on their frequency of examining CBCT cases involving the skull base.
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Validation of a Method to Measure the T2 Value from the Color Mapping by Hue Value
Authors: Takehito Hananouchi and Makishi NakayamaBackground: Color mapping using quantitative MRI (Magnetic Resonance Imaging) is now being reported in various medical fields to be useful in showing tissue conditions and morphological perspectives. Specifically, T2 mapping, as one of the color mapping has been used to describe cartilage conditions in orthopedics. However, for orthopedic physicians in outpatient clinics, the color mapping shows only the colors on the mapping to patients without explaining their numerical values. Methods: Our study proposed an approach to measure T2 values based on the hue value converted from Red, Green, Blue information on the processed color map to address this issue. We evaluated the validity of our method with 25 subjects. Results: Our proposed method showed a good and high correlation coefficient (r = 0.9924, p < 0.0001), and the difference in the T2 values using dedicated software on the console of the MRI scanner and our method was small (its absolute value was approximately 1.5, p = 0.008). Conclusion: Therefore, we consider the proposed method is an alternative approach to show the T2 value when the color mapping is available.
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Medical Students’ Perspectives on Artificial Intelligence in Radiology: The Current Understanding and Impact on Radiology as a Future Specialty Choice
By Ali AlamerBackground: Medical students' career choices and motivations might be significantly impacted by the rapid advances in artificial intelligence (AI) and the recent hype around it. Objective: This study aimed to assess the impact of AI on medical students’ preferences for radiology as a future specialty choice. Methods: A cross-sectional study was conducted between October and December 2021 among all medical students in the three regional medical colleges in Al-Qassim Province, Saudi Arabia. Results: The survey resulted in 319 complete responses. Among the respondents, 26.96% considered radiology to be one of their top three future specialty choices. Only a minority of the respondents (23.2%) believed that radiologists would be replaced by AI during their lifetime. The misperceptions of the potential impact of AI led 22.26% of the students to be less likely to consider a career in radiology. Students with an interest in radiology were less influenced by such misperceptions (p=.01). Based on self-reported confidence measures, the basic understanding of AI was higher among students with an interest in radiology and students with prior exposure to AI (p<.05). Conclusion: The students' preferences for radiology as a future specialty choice were influenced by their misperceptions of the potential impact of AI on the discipline. Students' interest in radiology and prior exposure to AI helped them grasp AI and eliminate the hype around it.
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Does Diffusion Restriction Pattern on MRI Predict Stroke Etiology in a Cancer Patient?
Authors: Mehmet Kolukisa, Bahar A. Koyuncu, Alisan Bayrakoglu and Talip AsilBackground: Stroke and cancer are two of the most common health problems. Moreover, stroke is more common in patients with cancer than in the normal population, due to coagulation problems. Knowing the etiology of stroke is important for determining treatment options. This study aimed to determine the relationship between ischemic lesion topographies using diffusion-weighted magnetic resonance imaging (MRI) and the etiology of stroke in patients with cancer. Patients and Methods: All patients with ischemic stroke in the Bezmialem Stroke Registry over a 4- year period were retrospectively analyzed in this study. Patients with acute ischemic stroke and additional diagnoses of solid and active malignancy (excluding hematologic malignancies) were included in the analysis. We investigated whether there was a relationship between the etiology of patients with cancer-related stroke according to the stroke etiologic classification and the diffusion restriction patterns on MRI. Results: In this registry, 32 of 1472 patients were diagnosed as having active cancer. Fourteen patients were evaluated as having definite cardioembolism, eight patients as probable cardioembolism, and four patients had inadequate examinations. Only one patient was classified as having an atherothrombotic stroke. Isolated acute infarction was seen in 15 of 32 patients. In patients with multiple acute infarct areas (n=17), acute lesions characterized by micro embolisms in a single vessel area were detected in four patients, and acute lesions characterized by bilateral (anterior and/or posterior system) micro embolisms in more than one vessel area in 13 patients. Conclusion: The most common etiology of stroke in patients with cancer was found to be embolic/ cardioembolic. This is important for the treatment plans for ischemic stroke in patients with cancer.
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Imaging Profile After Treatment with Tocilizumab in COVID-19: A Case Series
Introduction: COVID-19 is a pandemic disease, mainly affecting the respiratory tract, triggering an inflammatory cascade complicated by multiorgan failure up to death. Among the tested medications for this disease, tocilizumab appears to act directly on the inflammatory cascade, improving COVID-19 outcomes. For this reason, we have tested the efficacy of tocilizumab on lung damage using chest computed tomography (CT). CASE Presentation: The study was conducted on twenty-one hospitalised COVID-19 patients between March-June 2020. Patients were divided into 2 groups according to the therapies administered (TCZ group= treatment with tocilizumab and NTZ group= other therapies). At admission, TCZ group presented worse laboratory test values, respiratory profile (PaO2/FiO2 ratio: 145.37±38.16 mmHg vs 257.9±95.3 mmHg of NTZ group, P<0.01) and radiological signs (multifocal opacity at chest-X-ray: 88% vs 23% of NTZ group, P<0.01). After performing chest CT during the clinical recovery, the scans of the 2 groups were compared and we observed that some features (e.g., ground glass opacity, consolidation and parenchymal bands) were less marked in the TCZ group. Conclusion: In our study, patients treated with tocilizumab presented a worse overall clinical and radiological profile at admission, but the control CT showed a similar imaging profile to patients treated with standard therapy. Based on this evidence, we may suggest that tocilizumab plays an important role in COVID-19 patients in reducing lung inflammation.
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A Huge Gastric Angiolipoma Presenting with Acute Upper Gastrointestinal Hemorrhage: A Case Report
Authors: Joo H. Choi, Sung Bin Park, Jong Beum Lee, Tae-Jin Lee, Hyun Jeong Park and Eun Sun LeeBackground: Angiolipoma is a benign neoplasm mainly composed of adipose tissue and proliferating blood vessels and is relatively rare in the gastrointestinal tract. And among them, gastric angiolipomas are extremely rare and tend to be small. Case Presentation: We report the clinical and imaging features of a patient with a huge angiolipoma in the stomach and an episode of hematemesis and melena, caused by the ulceration of the gastric mucosa overlying the gastric subepithelial angiolipoma revealed by the endoscopic evaluation. The patient was anemic, and the anemia resolved after local surgical resection of the tumor. We also reviewed the imaging and histological features of the presenting gastric angiolipoma. Conclusion: Radiologists should be aware of this rare benign gastric tumor that may present with gastrointestinal hemorrhage.
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A Sciatic Neuralgia Case of an Entrapment Neuropathy Mimicking Piriformis Syndrome Due to Soft Tissue Hemangioma
Authors: Şeref B. Arik and Elif GünaydinBackground: Lumbosacral pain is commonly seen in daily clinical practice. In fact, entrapment of the part of the sciatic nerve after the sacral foramen causes some of these pains, which should not be overlooked. The sciatic nerve may be compressed during its course after the sacral foramen for a variety of reasons. We aimed in this article to review extra-spinal compressive sciatic neuropathy reasons and abnormal magnetic resonance imaging (MRI) by presenting a sciatic neuralgia case of an entrapment neuropathy mimicking piriformis syndrome due to soft tissue hemangioma. Case Presentation: A 30-year-old male patient was admitted with complaints of lumbosacral pain spreading to the leg that had been worsening over the previous 10 days. With the preliminary diagnosis of labral damage and piriformis syndrome, the patient was referred to the radiology clinic for a hip MRI. In the hip MR images, a mass lesion suggestive of heterogeneously enhanced soft tissue hemangioma after the injection of paramagnetic contrast material was observed in the proximal left thigh. The soft tissue hemangioma extends towards the obturator foramen and compresses the sciatic nerve proximal to the femur after the sciatic foramen. Conclusion: The diagnosis of lower extremity entrapment neuropathy is frequently misdiagnosed. In these cases, MRI becomes more important for accurate diagnosis. The radiologists' knowledge of the sciatic nerve in MRI, regional anatomy during the course of the sciatic nerve, and abnormal nerve imaging findings will aid in the diagnosis.
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A Case of Intracranial Space-occupying Lesion Caused by Infection of AIDS-associated Talaromyces Marnefei
Authors: Shuyi Xie, Lieguang Zhang, Deyang Huang, Yanhong Yang, Zhiping Zhang, Yanhua Xiao, Xiaoping Tang and Jinxin LiuBackground: Talaromyces marneffei (T. marneffei) is a heat-dimorphic fungus that commonly causes fatal opportunistic infections in immunocompromised patients, such as those with human immunodeficiency virus (HIV) infection. Case Presentation: In this case report we describe a case of intracranial infection of T. marneffei in a 42-year-old AIDS patient. Contrast enhanced MRI showed the left occipital lobe mass with ring enhancement, MRS showed elevated AAs and Lip waves in the mass. Surgical resection of the occipital lobe confirmed the lesion to be T. marneffei infection and possibly with tuberculosis after a pathological examination. Patients with intracranial ring enhancing space-occupying lesions on MRI should be considered for intracranial T. marneffei infection. Intracranial T. marneffei infection is relatively rarely reported and recently studied. Conclusion: The MRI, in this case, suggests that ring enhancement mass and elevated AAs and Lip waves are helpful in the diagnosis of T. marneffei infection.
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Scrotal Leiomyoma: A Case Report of a Rare Intra-Scrotal Benign Mass
By Peipei WangIntroduction: Scrotal leiomyoma is a rare benign mesenchymal neoplasm that originates from smooth muscles. Up to now, the exact tumor properties remain unclear. Case Presentation: A 53-year-old male presented with intermittent mild pain and constant heaviness in the right scrotum for 1 year. The physical examination revealed a 6.5 cm by 5.5 cm by 5.5 cm sized, firm, mobile and non-tender lump within the inferior right scrotum. The ultrasound examination revealed a well-circumscribed and heterogenous hypoechoic tumor. MR imaging showed isointense on T1-weighted images, hypointense on T2-weighted images, and mild enhancement on post-contrast sequences. Then, he received simple tumor excision and further pathological examination demonstrated the diagnosis of typical leiomyoma. Conclusion: A full understanding of these rare tumor properties is the key to administering optimal treatment.
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Cryptococcal Osteomyelitis of the Left Acetabulum: A Case Report
Authors: Changning Zhou, Jing Zhang, Yang Chen, Xing Ding, Fen Chen, Kai Feng and Kuntao ChenBackground: Cryptococcus, as a classical "opportunistic" fungal pathogen, is capable of disseminating an invasive infection in immunocompromised hosts. The primary sites of infection include the respiratory and central nervous systems, and skeletal infection was rarely reported. In this case, we describe a case of cryptococcal osteomyelitis involving the left side of the acetabulum in a Chinese patient with chronic hepatitis B. Case Presentation: We retrospectively reviewed the case of a female (with chronic hepatitis B) with left acetabulum pain and limited mobility, with fever occurring during the infection who presented to the Fifth Affiliated Hospital of Zunyi Medical University. Upon imaging, we found osteolytic bone destruction in the left acetabulum with inflammatory changes in the surrounding bone and soft tissue, accompanied by abscess formation. Following an 11-month of antifungal therapy, the clinical symptoms improved and the lesion area reduced in size. In addition, there was no sign of recurrence. Conclusion: Cryptococcus infections should be considered in the differential diagnosis of infectious osteolytic bone lesions, particularly when patients with immune insufficiency. Pathological examinations and fungal cultures are essential to provide a differential diagnosis.
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Volumes & issues
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Volume 20 (2024)
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Volume 19 (2023)
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Volume 18 (2022)
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Volume 17 (2021)
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Volume 16 (2020)
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Volume 15 (2019)
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Volume 14 (2018)
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Volume 13 (2017)
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Volume 12 (2016)
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Volume 11 (2015)
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Volume 10 (2014)
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Volume 9 (2013)
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Volume 8 (2012)
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Volume 7 (2011)
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Volume 6 (2010)
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Volume 5 (2009)
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Volume 4 (2008)
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Volume 3 (2007)
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Volume 2 (2006)
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Volume 1 (2005)