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Current Medical Imaging - Current Issue
Volume 20, Issue 1, 2024
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Breast Edema of Early-stage Invasive Ductal Carcinoma: Correlation with Axillary Lymph Node Metastasis and Clinical-pathological Characteristics
Authors: Yang Zhang, Yuqing Xin, Nana Zhang, Xiankuo Hu, Bin Peng, Shaohua Zhang and Yushan YuanObjectiveThis study aimed to evaluate the association of different patterns of breast edema and clinical-pathological features and axillary lymph node (ALN) status in early invasive ductal carcinoma (IDC) for simple and readily available assessment and to guide surgeons to perform sentinel lymph node biopsy for selected patients.
Materials and MethodsThis retrospective analysis involved 207 individuals with clinical T1-T2 stage IDC. The clinical-pathological features of the patients were compared with different breast edema and ALN statuses. Independent risk factors for ALN metastasis were verified using multivariate logistic regression analysis.
ResultsALN metastasis was confirmed in 100 of 207 patients (48.3%) with early-stage IDC. Significant differences were found between different ALN states for tumour size, clinical T stage, and breast edema (P <0.05). The clinical T2 stage (odds ratio-1.882, p=0.043) and moderate to severe edema (odds ratio-10.869, p=0.004) were independent risk factors for ALN metastasis. Moreover, better prognostic factors, including smaller tumour size, lower Ki-67 index and histologic grade, luminal A subtype, and lower incidence of lymph node metastasis, were more frequently found in patients with no breast edema (p<0.05).
ConclusionBreast edema can be considered a promising feature to improve the predictive performance of pathological ALN status in patients with early-stage breast cancer and thus may contribute to preoperative treatment planning.
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Contrast-enhanced Ultrasonography for Diagnosis of Small Intestinal Leiomyosarcoma with Hepatic Metastasis: A Clinical Report of One Case and Review of the Literature
Authors: Jiubo Sun, Gang Li, Xiaoguang Huo, Ning Fang, Xiaofei Wang and Wenzhe XuBackgroundSmall intestinal leiomyosarcoma is a rare malignant tumor of the gastrointestinal tract. Clinical symptoms are atypical and can be complicated by gastrointestinal bleeding and intestinal obstruction.
Case PresentationWe report a case of a 73-year-old patient with small intestinal smooth muscle sarcoma with hepatic metastasis. No significant abnormalities were seen on examination of the abdomen. We performed abdominal enhancement CT, contrast-enhanced ultrasonography (CEUS), and ultrasound-guided pelvic mass puncture biopsy, and we found a heterogeneous density and echogenicity of the pelvic mass, and the enhancement was progressive with sustained hyperenhancement. The postoperative pathology was smooth muscle sarcoma of the small intestine. The typical fast-in, fast-out bull's-eye sign of metastases, characterized the liver presented with multiple hypodense and echogenic nodules and the enhancement. The clinical presentation, imaging, histologic features, and treatment are also discussed in this article.
ConclusionThis article briefly reviews the literature on small intestinal leiomyosarcoma. The purpose of this case report is to emphasize the specificity of the case and evaluate the imaging presentation of ultrasound (US) and CEUS and the main differential diagnosis of this rare gastrointestinal tumor.
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Transperitoneal Laparoscopic Adrenalectomy for Metachronous Contralateral Adrenal Metastasis from Oligometastatic Renal Cell Cancer: Case Report and Review of the Literature
Authors: Ercan Ogreden, Ural Oğuz, Erhan Demirelli, Doğan Sabri Tok, Safa Akyol, Hülya Öksüz and Serdar AslanBackgroundThe definition of oligometastasis is still controversial. Cytoreductive nephrectomy and metastasectomy are important approaches in selected patients with oligometastasis for improving survival. We aimed to present our laparoscopic metastasectomy experience in a rare case of contralateral adrenal metastasis in an oligometastatic kidney tumor.
Case ReportA 52-year-old male patient was admitted to our clinic with the diagnosis of an incidental right renal mass. On contrast-enhanced abdominal CT revealed a mass reaching approximately 8 cm in diameter in the right kidney located in the middle pole. On contrast-enhanced thorax, CT showed a metastatic lesion in the left main bronchus bifurcation. The patient underwent an open radical nephrectomy with the diagnosis of an oligometastatic right renal mass. His pathology was reported as clear cell renal cell carcinoma (ccRCC). The patient was referred to the medical oncology clinic for immunotherapy. The metastatic lesion in the lung completely regressed in the follow-up of the patient who was started on Chek point inhibitors. However, he was referred to our clinic after an incidental metachronous mass was detected in the contralateral left adrenal in FDG PET/CT (SUVmax: 6.7) in 1st year. Dynamic contrast-enhanced MRI was performed to reevaluate and for mass characterization, and a 4 cm mass was observed in the left contralateral adrenal. Laparoscopic metastasectomy was performed for the left adrenal mass. No recurrence or adrenal insufficiency developed in the 6-month follow-up after discharge.
ConclusionTransperitoneal adrenalectomy is a minimally invasive method that can be safely performed in metastatic adrenal masses. Although contralateral adrenal metastasis is rare in ccRCC, it should be kept in mind that adrenal metastasis may develop in the late period in patients with a history of renal cancer.
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CAD System Design for Pituitary Tumor Classification based on Transfer Learning Technique
Authors: Sagrika Gargya and Shruti JainBackgroundA brain tumor is an asymmetrical expansion by cells inevitably emulating amid them. Image processing is a vibrant research area where the handing out of the image in the medical field is an exceedingly tricky field. In this paper, an expert algorithm is suggested for the detection of pituitary brain tumors from MR images.
MethodsThe preprocessing techniques (smoothing, edge detection, filtering) and segmentation techniques (watershed) are applied to the online data set. The transfer learning technique is used as a classifier whose performance is measured in terms of classification accuracy. Resnet 50, Inception V3VGG16, and VGG19 models are used as classification algorithms. The proposed model is validated using different machine learning techniques considering hybrid features.
Results96% accuracy was obtained employing the Inception V3 model & 95% accuracy was attained using hybrid GLDS and GLCM features employing Support Vector Machine algorithm while 93% was attained using Probabilistic Neural Network and k Nearest Neighbor techniques.
ConclusionComputer-aided systems gave much faster and more accurate results than image processing techniques.1.0% accuracy improvement was observed while using Inception V3 over GLDS + GLCM + SVM and 2.1% accuracy improvement using GLDS + GLCM + SVM over GLDS + GLCM + kNN.
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Benign Multicystic Peritoneal Mesothelioma: Two Rare Cases and Review of the Literature
Authors: Mustafa Mehmet Incesu, Murat Ucar, Ramazan Kozan, Berkay Simsek and Guldal EsendagliBackgroundBenign multicystic peritoneal mesothelioma is a multiloculated cystic mass which originates from the peritoneum. This rare tumor is usually seen in women of childbearing age and has a high recurrence rate after surgery.
Case PresentationWe present two benign multicystic peritoneal mesothelioma cases with different imaging modalities, which were also pathologically proven.
ConclusionThe imaging features which may be diagnostic should be well known as there are very few reports regarding this entity.
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Radiomics in the Diagnosis of Gastric Cancer: Current Status and Future Perspectives
Authors: Zhiqiang Wang, Weiran Li, Di Jin and Bing FanGastric cancer is a malignant cancerous lesion with high morbidity and mortality. Preoperative diagnosis of gastric cancer is challenging owing to the presentation of atypical symptoms and the diversity of occurrence of focal gastric lesions. Therefore, an endoscopic biopsy is used to diagnose gastric cancer in combination with imaging examination for a comprehensive evaluation of the local tumor range (T), lymph node status (N), and distant metastasis (M). The resolution of imaging examinations has significantly improved with the technological advancement in this sector. However, imaging examinations can barely provide valuable information. In clinical practice, an examination method that can provide information on the biological behavior of the tumor is critical to strategizing the treatment plan. Artificial intelligence (AI) allows for such an inspection procedure by reflecting the histological features of lesions using quantitative information extracted from images. Currently, AI is widely employed across various medical fields, especially in the processing of medical images. The basic application process of radiomics has been described in this study, and its role in clinical studies of gastric cancer has been discussed.
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Chest CT Image based Lung Disease Classification – A Review
Computed tomography (CT) scans are widely used to diagnose lung conditions due to their ability to provide a detailed overview of the body's respiratory system. Despite its popularity, visual examination of CT scan images can lead to misinterpretations that impede a timely diagnosis. Utilizing technology to evaluate images for disease detection is also a challenge. As a result, there is a significant demand for more advanced systems that can accurately classify lung diseases from CT scan images. In this work, we provide an extensive analysis of different approaches and their performances that can help young researchers to build more advanced systems. First, we briefly introduce diagnosis and treatment procedures for various lung diseases. Then, a brief description of existing methods used for the classification of lung diseases is presented. Later, an overview of the general procedures for lung disease classification using machine learning (ML) is provided. Furthermore, an overview of recent progress in ML-based classification of lung diseases is provided. Finally, existing challenges in ML techniques are presented. It is concluded that deep learning techniques have revolutionized the early identification of lung disorders. We expect that this work will equip medical professionals with the awareness they require in order to recognize and classify certain medical disorders.
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Comparison of Computed Tomography Findings between Adult and Pediatric COVID-19 Patients
PurposeThis study aims to compare chest computed tomography (CT) findings between adult and pediatric patients with coronavirus disease-19 (COVID-19) pneumonia.
Materials and MethodsThis study included 30 pediatric patients aged 1 to 17 years and 30 adult patients over 18 years of age with COVID-19 pneumonia confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) who have findings related to COVID-19 on Chest Computed Tomography. The CT findings of adult and pediatric patients were compared with a z-test.
ResultsBilateral involvement (p:0.00056), involvement in all five lobes (p<0.00001), and central and peripheral involvement (p:0.01928) were significantly higher in the adult group compared to the pediatric group. In the pediatric group, the frequency of unilateral involvement (p:0.00056), involvement of solitary lobe (p:0.00132), and peripheral involvement (p: 0.01928) were significantly higher than in the adult group. The most common parenchymal finding in adults and pediatric patients was ground-glass opacities (100% and 83%, respectively). Among the parenchymal findings in adults, ground-glass opacities with consolidation (63%) were the second most common finding, followed by air bronchogram (60%) in adults, while in pediatric patients, halo sign (27%) and nodule (27%) were the second most common, followed by the ground-glass opacities with consolidation (23%).
ConclusionThe CT findings of pediatric COVID-19 patients must be well-known as the course of the disease is usually less severe, and the radiological findings are uncertain when compared with adults.
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Age and Gender-related Morphometric Assessment and Degenerative Changes of Temporomandibular Joint in Symptomatic Subjects and Controls using Cone Beam Computed Tomography (CBCT): A Comparative Analysis
Authors: Xiaoyin Hu, Bhavana Sujanamulk, Chintamaneni Raja Lakshmi and Changhui LiBackgroundThe temporomandibular joint diseases have been associated with various predisposing factors. Joint spaces, articular eminence height and inclination, and the shapes of the condylar and glenoid fossa have all been shown to vary in temporomandibular joint diseases (TMD) patients. Advanced imaging techniques like cone beam computed tomography (CBCT) have been employed to estimate these parameters.
Aims and ObjectivesThe aim of the current study was to investigate the condylar morphology, condylar and glenoid fossa shapes, and assessment of joint spaces, such as anterior, posterior, superior, lateral, and medial spaces, through CBCT slices in coronal and sagittal planes and compare them between the control group and TMD group.
Materials and MethodsA cross-sectional study was planned where 80 joints in 40 patients were assessed for the above parameters; group I consisted of healthy patients, and group II included those with temporomandibular joint diseases (TMDs). The articular eminence height and inclination were assessed on the midsagittal section. The condylar changes and shapes of the glenoid fossa and condyles, as well as the joint spaces, were assessed on the selected coronal and sagittal sections.
ResultsThe condylar fossa had a triangular shape in the TMJ group and an oval shape in the control group. The results were highly significant (P = 0.000**). A highly significant difference in morphological parameters, such as AJS, PJS, SJS, MJS, LJS, articular eminence height, and inclination, was found between the two groups (P = 0.000**). The association of morphological parameters, such as AJS, PJS, SJS, MJS, LJS, and articular eminence height and inclination were compared with condylar and glenoid fossa shapes, where the association of superior joint space and articular eminence inclination was observed. A highly significant difference was noted between the two groups with regard to all the parameters with P=0.00*.
ConclusionThe articular eminence inclination, as well as the superior joint space, were found to be associated with the glenoid and condyle fossa shapes in the TMJ group. These observations would, therefore, help in the early diagnosis of temporomandibular joint diseases.
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Discrepancies between Screening Sonography and Ultrasound in Emergency Department – A Case Report
IntroductionThis case report presents a discrepancy in sonographic findings between a screening sonography performed by a Sonographer in the Basic Emergency Service (BES) and a subsequent ultrasound performed by a Radiologist physician in a Referral Hospital (RH). The aim of this report is to discuss the possible reasons for the discrepancy and its implications for patient care.
Case PresentationA patient with a history of epigastric pain and vomiting underwent screening sonography in a BES, which suggested Intrahepatic Biliary Dilatation Duct (IHBD) and main pancreatic duct dilatation. The patient was subsequently referred to the RH for further evaluation. However, the Radiologist in the RH did not confirm any of the initial suspicions from BES through a normal ultrasound procedure. The discrepancy raises questions regarding the quality of the screening ultrasound, misinterpretation of the BES images, or the potential for ambiguity in the point of care ultrasound (POCUS) exam.
ConclusionThe differences in sonographic findings between BES and RH, in this case, suggest that the improvement of the patient's clinical condition and therapeutic interventions may have contributed to the discrepancy. Further investigation and standardization of POCUS training and interpretation may improve diagnostic accuracy and patient outcomes.
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Coexistence of Large Meningioma and Arteriovenous Malformation: A Case Report and Literature Review
Authors: Xue Wang, Yang Liu, Rong-Wu Tang and Ye TaoZhuIntroductionThe simultaneous presence of a giant intracranial meningioma and an arteriovenous malformation(AVM)in the same cerebral hemisphere is extremely rare. The treatment should be individualized depending on the case.
Case PresentationA 49-year-old man presented with hemiparesis. Preoperative neuroimaging revealed a giant lesion and an AVM on the left hemisphere of the brain. Craniotomy and tumour resection were performed. The AVM was not treated and needed to be followed up. The histological diagnosis was meningioma (World Health Organization grade I). The patient was in good neurological condition postoperatively.
ConclusionThis case adds to the growing literature suggesting that the association between the two lesions is complex. Besides, treatment depends on the risk of neurologic function damage and hemorrhagic stroke of meningiomas and AVMs.
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A Segmentation Method of Serialized Human Body Slices based on Matting Strategy and Skeleton Extraction
Authors: Bin Liu, Zhengyang Wu, Chenlu Wang, Shiyu Pang, Jingzhu Pei, Jianxin Zhang and Liang YangIntroductionIn this paper, a semiautomatic image segmentation method for the serialized body slices of the Visible Human Project (VHP) is proposed.
MethodsIn our method, we first verified the effectiveness of the shared matting method for the VHP slices and utilized it to segment a single image. Then, to meet the need for the automatic segmentation of serialized slice images, a method based on the parallel refinement method and flood-fill method was designed. The ROI (region of interest) image of the next slice can be extracted by using the skeleton image of the ROI in the current slice.
ResultsUtilizing this strategy, the color slice images of the Visible Human body can be continuously and serially segmented. This method is not complex but is rapid and automatic with less manual participation.
ConclusionThe experimental results show that the primary organs of the Visible Human body can be accurately extracted.
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Deep Learning-reconstructed Parallel Accelerated Imaging for Knee MRI
Authors: Sang-Min Lee, MinWoo Kim, Chankue Park, Dongeon Lee, Kang Soo Kim, Hee Seok Jeong and Min-Hyeok ChoiBackgroundDeep learning (DL) can improve image quality by removing noise from accelerated MRI.
ObjectiveTo compare the quality of various accelerated imaging applications in knee MRI with and without DL.
MethodsWe analyzed 44 knee MRI scans from 38 adult patients using the DL-reconstructed parallel acquisition technique (PAT) between May 2021 and April 2022. The participants underwent sagittal fat-saturated T2-weighted turbo-spin-echo accelerated imaging without DL (PAT-2 [2-fold parallel accelerated imaging], PAT-3, and PAT-4) and with DL (DL with PAT-3 [PAT-3DL] and PAT-4 [PAT-4DL]). Two readers independently evaluated subjective image quality (diagnostic confidence of knee joint abnormalities, subjective noise and sharpness, and overall image quality) using a 4-point grading system (1-4, 4=best). Objective image quality was assessed based on noise (noise power) and sharpness (edge rise distance).
ResultsThe mean acquisition times for PAT-2, PAT-3, PAT-4, PAT-3DL, and PAT-4DL sequences were 2:55, 2:04, 1:33, 2:04, and 1:33 min, respectively. Regarding subjective image quality, PAT-3DL and PAT-4DL scored higher than PAT-2. Objectively, DL-reconstructed imaging had significantly lower noise than PAT-3 and PAT-4 (P <0.001), but the results were not significantly different from those for PAT-2 (P >0.988). Objective image sharpness did not differ significantly among the imaging combinations (P =0.470). The inter-reader reliability ranged from good to excellent (κ = 0.761–0.832).
ConclusionPAT-4DL imaging in knee MRI exhibits similar subjective image quality, objective noise, and sharpness levels compared with conventional PAT-2 imaging, with an acquisition time reduction of 47%.
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Is there a Relationship between Vertical Facial Development and Nasal Cavity?
Authors: Sanaz Sadry and Esra SomtürkObjectivesThe aim of this study was to examine the relationship between vertical direction differences and the nasal cavity in skeletal Class I individuals.
Materials and MethodsThis study was divided into 2 groups according to the vertical direction angle, and it was conducted on a total of 60 individuals with skeletal Class I features, with 30 individuals in each subgroup. Angular and millimetric measurements (N-ANS, ANS-ME, N-ME, Ba-N/Ptm-Gn°, nasal septum, nasal cavity width (NCL), nasal cavity angle° (NCA)) were made in accordance with the parameters determined on cone beam computed tomography (CBCT) before the treatment of the individuals constituting the research groups. In a retrospective study, the relationship between vertical skeletal development of the nasal cavity on CBCT images was examined in detail. The Mann-Whitney U test was used, and Student's t test was used to compare two groups with a normal distribution. Spearman's correlation analysis was used to determine the relationship between quantitative data.
ResultsIn the comparison of Class I vertical direction subgroups, a statistically significant difference was found in terms of measurement values ANS-Me and N-Me, nasal cavity width and angular measurements (p<0.001) According to the results of the Mann-Whitney U test, men had significantly higher measurements of the sex and nasal cavity than women (p = 0.001; p<0.001).
ConclusionClass I individuals with different vertical direction dimensions were affected by changes in the nasal cavity during vertical development.
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Discrimination between Benign and Malignant Lung Lesions using Volumetric Quantitative Dynamic Contrast-enhanced MRI
Authors: Fang Wei, Fu Weidong, Zhou Wenming, He Lei, Cheng Xiaosan, Mao Zhongliang, Liu Qianyun and Lin HuashanBackgroundDynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is considered a promising method in lung lesion assessment.
MethodsSixty-four patients with single pulmonary lesions (SPLs) received DCE-MRI at 3.0 T. Of them, 49 cases were diagnosed with lung cancer, and 15 with benign pulmonary nodules (8 inflammatory nodules, 5 tuberculosis, and 2 abscesses). SPLs were quantitatively analyzed to determine the pulmonary lesions-related perfusion parameters, including reflux constant (Kep), volume transfer constant (Ktrans), the maximum slope of increase (MaxSlope), extravascular extracellular space volume fraction (Ve), apparent diffusion coefficient (ADC), the initial area in the signal intensity-time curve (IAUGC), and contrast-enhancement ratio (CER). In addition, a Student’s t-test was conducted to calculate statistical significance regarding the quantitatively analyzed perfusion parameters in benign SPLs compared to malignant SPLs. The area under (AUC) the receiver operating characteristic (ROC) curve was studied to investigate the performance of perfusion parameters in diagnosing lung cancer.
ResultsValues of Ktrans, Kep, Ve, MaxSlope, and IAUGC increased within malignant nodules relative to benign nodules (Ktrans: 0.21 ±0.08 vs. 0.73 ±0.40, P = 0.0001; Kep: 1.21 ±0.66 vs. 1.83 ±0.90, P = 0.0163; Ve: 0.24 ±0.08 vs. 0.47 ±0.18, P < 0.0001; MaxSlope: 0.09 ±0.14 vs. 0.28 ±0.29, P = 0.0166; IAUGC: 0.18 ±0.09 vs. 0.55 ±0.34, P = 0.0001). Meanwhile, malignant nodules presented higher ADC than benign nodules (0.0016 ±0.0006 vs. 0.0012 ±0.0003, P = 0.0019). Ktrans and IAUGC showed the best diagnostic performance with AUCs [1.0, 95%CI (0.99–1.0); 0.93, 95%CI(0.85–1.0), respectively].
ConclusionMalignant pulmonary lesions had higher values of Ktrans, Ve, Kep, MaxSlope, and IAUGC compared to benign pulmonary lesions. Overall, perfusion parameters of DCE-MRI facilitate discrimination between benign from malignant pulmonary nodules.
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An Extra-articular Ganglion Cyst with Multiple Fluid-fluid Levels
Authors: Semra Duran, Cem Cuneyt Kose and Servet GuresciIntroductionGanglion cysts are the knee’s most common benign soft tissue tumors. Ganglion cysts are seen as multiloculated fluid collections on magnetic resonance imaging (MRI), and fluid-fluid levels are not an expected finding.
Case PresentationA 36-year-old female patient presented with swelling in her right knee. Magnetic resonance imaging revealed a multiseptated cyst with multiple fluid-fluid levels within the anterior of the right patellar tendon. Open surgical excision was performed, and the pedicle of the cyst was dissected. The histopathology revealed a ganglion cyst with hemorrhage.
ConclusionThe ganglion cysts should be considered in the differential diagnosis of lesions with fluid-fluid levels, in addition to hemangioma, synovial sarcoma, and aneurysmal bone cysts of soft tissues.
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The Evaluation of Subcutaneous and Visceral Adipose Tissue Changes by Computed Tomography in Coronavirus Disease 2019 and Comparison with Quantitative Analysis of Lung Involvement
Authors: Murat Vural, Betul Akdal Dolek, Ozgul Ucar, Erdem Ozkan and Utku Eren OzkayaBackgroundThis study aims to reveal the relationship between lung involvement and visceral adipose tissue changes between chest-computed tomography (CT) scans taken in short intervals in COVID-19 patients.
MethodsThe retrospective study included 52 patients who tested positive for SARS-CoV-2. All patients had two chest CT exams. Lung involvement measurements were calculated by using an artificial intelligence tool. Visceral and subcutaneous fat tissue was measured at the level of the first lumbar vertebra on chest CT. Additionally, demographic and laboratory data were collected.
Results52 patients were included (36.5% female, mean age 50). Visceral fat area and visceral fat thickness changes were significantly positive predictors of total lung involvement changes (p=0.033, p=0.00024). Subcutaneous fat area and subcutaneous fat thickness changes were not associated with lung involvement change (p>0.05). CRP, IL-6, d-dimer, and ferritin levels were higher in patients who need intensive care units.
ConclusionVisceral adipose tissue changes may indicate that it can have a role as a reservoir of virus involvement.
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Value of Multimodal Diffusion-weighted Imaging in Preoperative Evaluation of Ki-67 Expression in Endometrial Carcinoma
Authors: Huan Meng, Si-Xuan Ding, Yu Zhang, Feng-Ying Zhu, Jing Wang, Jia-Ning Wang, Bu-Lang Gao and Xiao-Ping YinPurposeTo investigate the value of multimodal diffusion weighted imaging (DWI) in preoperative evaluation of Ki-67 expression of endometrial carcinoma (EC).
Materials and MethodsPatients who had undergone pelvic DWI, intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) sequence MRI scan before surgery were retrospectively enrolled. Single index model, double index model, and DKI were used for post-processing of the DWI data, and the apparent diffusion coefficient (ADC), real diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), non-Gaussian mean diffusion kurtosis (MK), mean diffusion coefficient (MD) and anisotropy fraction (FA) were calculated and compared between the Ki-67 high (≥50%) and low (<50%) expression groups.
ResultsForty-two patients with a median age of 56 (range 37 - 75) years were enrolled, including 15 patients with a high Ki-67 (≥50%) expression and 27 with a low Ki-67 (<50%) expression. The MK (0.91 ± 0.12 vs. 0.76 ± 0.12) was significantly (P<0.05) higher while MD (0.99 ± 0.17 vs. 1.16 ± 0.22), D (0.55 ± 0.06 vs. 0.62 ± 0.08), and f (0.21 vs. 0.28) were significantly (P<0.05) lower in the high than in the low expression group. The combined model of MK, MD, D, and f-values had the largest area under the curve (AUC) value of 0.869 (95% CI: 0.764-0.974), sensitivity 0.733 and specificity 0.852, followed by the MK value with an AUC value 0.827 (95% CI: 0.700-0.954), sensitivity 0.733 and specificity 0.815.
ConclusionsIVIM and DKI have certain diagnostic values for preoperative evaluation of the EC Ki-67 expression, and the combined model has the highest diagnostic efficiency.
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Electromagnetically Navigated Tube Placement Device for Bedside Placement of Small Bowel Feeding Tube on Patients with Acute Severe Pancreatitis: Comparative Study
Authors: Guoliang Tan, Yongming Chen and Yanping LinBackgroundA developing approach for the bedside installation of feeding tubes is the Electromagnetic Navigation-assisted Tube Placement Device (ENTPD). The ENTPD monitors the tip position of feeding tubes when they are inserted into the digestive tract. It aids in the avoidance of airway misalignment and allows placing into the small bowel. Several recent exploratory studies have shown that ENTPD for nasojejunal feeding tube installation can improve success rates, lower costs, and allow for a more rapid beginning of enteral nutrition.
ObjectivesThe aim of this study was to compare the effect of using an ENTPD for bedside placement of small bowel feeding tubes with blind placement on patients with acute severe pancreatitis and to see how well the electromagnetic navigation trajectory image (ENTI) and X-ray agreed on the location of the tube tip after placement.
MethodsThe study was done prospectively using randomized and single-blind methods. The 65 cases used electromagnetic navigation-assisted placement, and 58 cases were blind placement. For judging the tube tip location, we compared the success rate, median time, number of repeat placements, complications, and agreement of ENTI vs. X-ray.
ResultsThe blind placement group's success rate was 86.21% compared to the ENTPD's 95.38%, P = 0.075. The median time was significantly longer in the blind placement group (116.55 ± 68.62 min vs. 25.37 ±12.63 min, P=0.000); the average number of repeating placements was 3.02 ± 1.21 vs. 1.16 ± 0.31 (Blind placement vs. ENTPD, P = 0.002). It provided a high degree of agreement between ENTI and X-ray after contrast, κ=0.752 [95% confidence interval, 0.67-0.84]. No complications occurred in the two groups.
ConclusionENTPD was used safely and effectively at the bedside to help patients with acute severe pancreatitis get feeding tubes. It not only improved the high successful rate of placement, decreased the time and reduced the exposure to X-ray, but it was also very convenient for bedside placement because of the portable equipment.
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An Automatic Method Framework for Personalized Knee Prosthetic Modeling Based on Kinematic Geometry
Authors: Pengxi Li, Hui Liu, Bocheng Zhang, Dongpei Liu, Liang Yang and Bin LiuThe shape of a knee prosthesis has an important impact on the effect of total knee arthroplasty. Comparing to a standard common prosthesis, the personalized prosthesis has inherent advantages. However, how to construct a personalized knee prosthesis has not been studied deeply. In this paper, we present an automatic method framework of modeling personalized knee prostheses based on shape statistics and kinematic geometry. Firstly, the average healthy knee model is established through an unsupervised process. Secondly, the sTEA (Surgical Transecpicondylar Axis) is calculated, and the average healthy knee model is resized according to it. Thirdly, the resized model is used to simulate the knee’s motion in a healthy state. Fourthly, according to the target patient's condition, an excising operation is simulated on both patient's knee model and the resized model to generate an initial knee prosthesis model. Finally, the initial prosthesis model is adjusted according to the simulated motion results. The average maximum error between the resized healthy knee model and the patient's own knee model is less than 2 mm, and the average maximum error between the motion simulation results and actual motion results is less than 3 mm. This framework can generate personalized knee prosthesis models according to the patient’s different conditions, which makes up for the deficiencies of standard common prostheses.
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An Early Detection and Classification of Alzheimer's Disease Framework Based on ResNet-50
Authors: V P Nithya, N Mohanasundaram and R. SanthoshObjective: The objective of this study is to develop a more effective early detection system for Alzheimer's disease (AD) using a Deep Residual Network (ResNet) model by addressing the issue of convolutional layers in conventional Convolutional Neural Networks (CNN) and applying image preprocessing techniques.
Methods: The proposed method involves using Contrast Limited Adaptive Histogram Equalizer (CLAHE) and Boosted Anisotropic Diffusion Filters (BADF) for equalization and noise removal and K-means clustering for segmentation. A ResNet-50 model with shortcut links between three residual layers is proposed to extract features more efficiently. ResNet-50 is preferred over other ResNet types due to its intermediate depth, striking a balance between computational efficiency and improved performance, making it a widely adopted and effective architecture for various computer vision tasks. While other ResNet variations may offer higher depths, they are more prone to overfitting and computational complexity, which can hinder their practical application. The proposed method is evaluated on a dataset of MRI scans of AD patients.
Results: The proposed method achieved high accuracy and minimum losses of 95% and 0.12, respectively. While some models showed better accuracy, they were prone to overfitting. In contrast, the suggested framework, based on the ResNet-50 model, demonstrated superior performance in terms of various performance metrics, providing a robust and reliable approach to Alzheimer's disease categorization.
Conclusion: The proposed ResNet-50 model with shortcut links between three residual layers, combined with image preprocessing techniques, provides an effective early detection system for AD. The study demonstrates the potential of deep learning and image processing techniques in developing accurate and efficient diagnostic tools for AD. The proposed method improves the existing approaches to AD classification and provides a promising framework for future research in this area.
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Multiple Parotid Sebaceous Lymphadenoma: A Case Report and Review of the Literature
Authors: Yanhui Yang, Mengjie Tang, Zhiyuan Wang, Yi Fu and Xiaoping YuIntroduction/Background: Sebaceous lymphadenoma is a rare parotid gland neoplasm. Up to now, there have been several studies that have discussed the imaging manifestations of salivary sebaceous lymphadenoma. In this paper, we have reported a case of multiple parotid sebaceous lymphadenoma demonstrated by ultrasound, CT scan, and MRI examinations, including diffusion-weighted imaging. To the best of our knowledge, this report is the first one on DWI findings of sebaceous lymphadenomas, and also the first report on multiple lesions in unilateral parotid gland.
Case Presentation: A 41-year-old woman presented with a nodule in the left parotid region. The lesion has grown slowly for 2 months and was not associated with any discomfort. Ultrasound, CT scan, and MRI examinations, including diffusion-weighted imaging, showed multiple nodules in the left parotid gland of a 41-year-old woman. These nodules were heterogeneous on CT scan and MRI examinations, and intratumorally multifocal fat and cystic areas were detected. On ultrasound examination images, these lesions were heterogeneous hypoechoic echotexture with multifocal irregular hyperechogenic areas, without significant blood flow. The patient underwent a left parotidectomy. Histopathologic sections showed nests of sebocytes distributed in lymphoid follicles and lymphocyte background, with obvious cystic changes. The patient recovered after receiving left parotidectomy. The microscopy diagnosis was parotid sebaceous lymphadenoma.
Conclusion: This case highlights the main imaging feature of parotid sebaceous lymphadenomas, namely an intraparotid heterogeneous nodule containing multifocal fat and cystic areas, and its possible origination from an intraparotid lymph node. This case also indicates that this rare lesion may involve multiple occurrences.
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Venous Air Embolism: Case Series of a Complication of Computed Tomography Pulmonary Angiography (CTPA) in the Emergency Department of Medicine
Introduction: Venous air embolism (VAE) consists of air entering vascular structures due to a pressure gradient generated during medical-surgical procedures. Most cases of VAE are iatrogenic.
Case Reports: Three hospitalised patients aged 23 to 86 years underwent venous air embolism (VAE) in the right heart system after performing CTPA. One of the patients died from a complication of venous thromboembolic disease (PE, coronary sinus thrombosis, mesenteric venous thrombosis).
Conclusion: CTPA is a procedure that a priori seems innocuous, but it can be a potential cause of death or serious consequences for patients undergoing radiological procedures where the administration of contrast and the use of an injector could be counterproductive. Radiologists and physicians responsible for the patient should be aware of vascular gas embolism after contrast injection in patients undergoing CTPA.
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Comprehensive Introspection of Magnetoresistive Sensors Applied in Biomedical Diagnostics
Authors: S. Vimala Gayathri and D. SubbulekshmiOver the recent years, magnetoresistive (MR) sensors in biosensing technologies have played a pivotal role in detecting and quantifying biomarkers. The article highly focuses on the potential implications of tunneling magnetoresistance (TMR), giant magnetoresistance (GMR), anisotropic magnetoresistance (AMR), and hybrid MR sensors over conventional prototypes. The study mainly elaborates on the sensor characteristics and their implementation in the biomedical domain. The encompassing evaluation reveals the findings that the TMR sensors are remarkably stable and sensitive, whereas the GMR sensors are highly robust and inexpensive, as determined by the detection level, accuracy, sensing distance, and sensitivity. In addition, it is stated that hybrid MR sensors have lower error rates than AMR sensors utilized in the limited research area.
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Identifying Tumor Deposits in Patients with Locally Advanced Rectal Cancer: using Multiplanar High-Resolution T2WI
Authors: Baohua Lv, Xiaojuan Cheng, Yanling Cheng, Zhaohua Wang and Erhu JinBackgroundThe prognosis of postoperative tumor deposits (TDs) is worse than positive lymph node metastases alone.
ObjectiveTo detect TDs by using multiplanar high-resolution T2-weighted imaging (HRT2WI).
Material and MethodsThis retrospective study enrolled 130 patients with locally advanced rectal cancer (LARC). Using pathology-proven tumor deposits (pTDs) as the gold standard, all patients were divided into the pTDs-negative and pTDs-positive groups, the correlation of clinicopathological factors and image features [such as MRI-detected tumor deposits (mTDs), MRI-detected metastatic lymph node (mLN), MRI-detected extramural vascular invasion (mEMVI), maximal extramural depth (EMD), etc.] with pTDs were analyzed by univariate analysis and multivariate binary logistic regression analysis, and the nomogram was established based on the latter. The diagnostic efficiency was evaluated by the receiver operating characteristic curve (ROC) analysis and area under curve (AUC).
ResultsmTDs, mLN, mEMVI, and EMD were significantly different between the pTDs-positive and pTDs-negative groups (P < 0.05), with the AUC of 0.767, 0.746, 0.664 and 0.644, respectively. mTDs and mLN were independent risk factors for pTDs (odds ratio: 5.74 and 3.90, P < 0.05). The AUC, sensitivity, specificity, negative predictive value, and accuracy of the nomogram were 0.814 (95% CI: 0.720 ~ 0.908), 73.9%, 79.4%, 93.4%, and 78.5%, respectively. Seventeen of 23 patients with pTDs were identified as mTDs, with a moderate agreement between pTDs and mTDs (Kappa=0.419).
ConclusionMultiplanar HRT2WI can be used as a preoperative diagnostic tool to identify TDs in LARC. The combined model constructed by mTDs and mLN shows a good diagnostic performance for TDs.
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Radiological Features of Rare Non-odontogenic Lesions of the Jaws
Authors: Murat Akkoyunlu, Emre Bulgurcu, Cagrı Delilbası and Nuran Sabi̇rBackgroundThe jaws can be affected by several lesions that manifest in the oral cavity, but little is known about non-odontogenic benign and malignant lesions and their radiological findings.
IntroductionOur aim was to discuss the imaging findings of non-odontogenic jaw lesions to help the surgeon in the diagnosis and formulating a differential diagnosis for this vast spectrum of jaw lesions with overlapping clinical and imaging appearances.
MethodsCT and MR images of the mandible, maxillofacial region, and neck were retrieved from the archive of the Radiology Department of Pamukkale University for the duration between 2012-2023 and assessed.
ResultsA total of 8125 CT and MR images were retrospectively analyzed. The mean age of the patients was 39.5 years in females and 43.2 in males, with a range varying from 15 to 72 years. Histopathologically approved benign and malignant non-odontogenic lesions were detected in only 19 patients out of 8125 images (0.23%). Osteomyelitis and abscess were the most common (n=3; 0.03%), followed by two cases (n=2; 0.02%) of each fibrous dysplasia, hemangioma, osteosarcoma, squamous cell carcinoma, and multiple myeloma, and one case (n=1; 0.01%) of each ossifying fibroma, osteoma, lymphoma, metastasis, and solitary bone cyst.
ConclusionAlthough non-odontogenic benign and malignant lesions of the jaw are rare, awareness of the radiological features of these lesions plays an important role in their diagnosis and management.
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Mammography and Ultrasonography Manifestations of Sclerosing Lymphocytic Lobulitis of the Breast: A Series of Seven Case Reports
Authors: Wanling Lin and Lingyun BaoObjectiveThe present study aimed to analyze mammography and ultrasonography (US) manifestations of sclerosing lymphocytic lobulitis (SLL) of the breast.
MethodsA total of 8 pathologically confirmed SLL lesions from seven women (with one patient having bilateral breast lesions) were included in the study. All patients underwent preoperative mammography and US examinations. The findings from both modalities were classified and compared to their corresponding clinical data.
ResultsFour patients were diagnosed with diabetes mellitus. Mammography results revealed that seven lesions presented as focal asymmetry or asymmetry. Seven lesions were observed as non-mass lesions on US examination. The most commonly observed US lesion features were as follows: seven lesions had focal non-ductal hypoechoic areas (87.5%), seven lesions exhibited posterior shadowing (87.5%), all lesions showed no vascularity or vessels in the rim (100%), no lesion had calcifications (0%), five lesions had an elasticity score of 3 (100%), one lesion showed retraction on the coronal plane (20%), and one lesion displayed a skipping sign on the coronal plane (20%). Based on these US findings, seven lesions (87.5%) were classified as BI-RADS 4.
ConclusionThe mammography findings for SLL are often nonspecific. However, the US features of SLL typically present as non-mass lesions. The absence of calcification and vascularity and no retraction on the coronal plane inside the lesion may help to differentiate this disease from the conventional forms of breast carcinoma.
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Comparison of Imaging Characteristics of Gangliogliomas between Child/Adolescent Group and Adult Group
Authors: Xuan Zheng, Quan Huang, Shao-Lei Guo, Meng-Sha Zou, Hui Zhu and Shi-Ting LiBackgroundGanglioglioma is a rare, slowly proliferating mixed glioneuronal tumor, with the highest incidence observed in children and young adults, but it can also occur in adults.
ObjectiveThis study aimed to compare the imaging characteristics of ganglioglioma in children/adolescents and adults to facilitate radiographic diagnosis.
MethodsIn this retrospective study, a total of 32 patients were included and divided into two groups: the child/adolescent group (age < 18 years, n=19) and the adult group (age ≥ 18 years, n=13). Various variables were analyzed, including maximum diameter, location, periphery, border, calcification, unenhanced CT attenuation, T1WI, T2WI/FLAIR, and DWI signal intensity, enhancement pattern, degree of enhancement, homogeneity of enhancement, solid/cystic component, peri-tumoral edema, intra-tumoral septa, peri-tumoral capsule, and intra-tumoral hemorrhage.
ResultsMost gangliogliomas were situated in the peripheral regions, particularly in the temporal lobe. The majority exhibited hypointense/isointense signals on T1WI and hyperintense signals on T2WI/FLAIR and DWI, with predominantly heterogeneous nodular enhancement. Peri-tumoral edema was significantly less frequent in the child/adolescent group, while marked enhancement was significantly more common in the adult group. There was no significant difference in maximum diameter between the child/adolescent group and the adult group.
ConclusionPeri-tumoral edema was significantly less prevalent in the child/adolescent group, whereas marked enhancement was significantly more frequent in the adult group. To ensure accurate results, a larger case series should be conducted to validate our findings.
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Predicting the Prognosis of Lung Cancer Patients Treated with Intensity-modulated Radiotherapy based on Radiomic Features
Authors: Helong Wang, Jing Xu, Yanling Bai, Yewei Wang, Wencheng Shao, Weikang Yun, Lina Feng and Jianyu XuAimsThis study aimed to develop a method for predicting short-term outcomes of lung cancer patients treated with intensity-modulated radiotherapy (IMRT) using radiomic features detected through computed tomography images.
MethodsA prediction model was developed based on a dataset of radiomic features obtained from 132 patients with lung cancer receiving IMRT. Dimension reduction was performed for the features using the maximum-relevance and minimum-redundancy (mRMR) algorithm, and the least absolute shrinkage and selection operator (LASSO) regression model was utilized to optimize feature selection for the IMRT-sensitivity prediction model. The model was constructed using binary logistic regression analysis and was evaluated using the concordance index (C-index), calibration plots, receiver operating characteristic curve, and decision curve analysis.
ResultsFifty features were selected from 1348 radiomic features using the mRMR method. Of these, three radiomic features were selected by LASSO logistic regression to construct the radiomics nomogram. The C-index of the model was 0.776 (95% confidence interval: 0.689–0.862) and 0.791 (95% confidence interval: 0.607–0.974) in the training and validation cohorts, respectively. Decision curve analysis showed that the radiomics nomogram was clinically useful.
ConclusionRadiomic features have the potential to be applied to predict the short-term efficacy of IMRT in patients with inoperable lung cancer.
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Intratesticular Vascular Architecture Seen by Ultrasound Microvascular Imaging (MicroV). Illustration of the Testis Vascular Anatomy
Authors: Carmela Visalli, Ignazio Salamone, Enricomaria Mormina and Michele GaetaThe testis is a richly vascularized organ supplied by low-flow thin caliber vessels that are only partially detected by traditional Doppler systems, such as color and power Doppler.
However, in the vascular representation, these techniques determine, albeit to different extents, a cut of the weak vessels due to the necessary application of wall filters that cut the disturbing frequencies responsible for artifacts generated by pulsations of the vascular walls and surrounding tissues.
These filters cut a specific range of disturbing frequencies, regardless of whether they may be generated by low-flow vessels.
Recently, a new technology, called Ultrasound Microvascular Imaging (MicroV) has been developed, which is particularly sensitive to slow flows. This new mode is based on new algorithms capable of better selecting the low frequencies according to the source of origin and cutting only the disturbing ones, saving the frequencies originating from really weak flows.
When Ultrasound microvascular imaging is used, the vascular map is more detailed and composed of macro and microvasculature, with more subdivision branches, facilitating the interpretation of the normal and, consequently, the pathological.
This review aims to describe the vascular architecture of the testis with Ultrasound Microvascular Imaging (MicroV) in healthy testis, compared to traditional color/power Doppler, related to normal anatomy.
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Assessment of Apparent Diffusion Coefficient Parameters and Coefficient of Variance in Discrimination of Receptor Status and Molecular Subtypes of Breast Cancer
Authors: Ozlem Ozkul, Ibrahim Sever and Bahattin OzkulObjectiveThe objective of this study was to investigate the diagnostic power of apparent diffusion coefficient/coefficient of variance (ADCcV) as well as ADC parameters formed based on magnetic resonance images (MRI) in the distinction of molecular breast cancer subtypes.
MethodsThe study involved 205 patients who had breast cancer at stages 1-3. Estrogen receptor (EsR), progesterone receptor (PrR), human epidermal growth factor receptor 2 (Her2), and proliferation index (Ki-67) were histologically analyzed in the tumor. The correlations between the immunohistochemistry and intrinsic subtypes were analyzed using ADC and ADCcV.
ResultsThe maximum whole tumor (WTu) ADC (p=0.004), minimum WTu ADC (p<0.001), and mean WTu ADC (p<0.001) values were significantly smaller in the EsR-positive tumors than those in the EsR-negative tumors. Compared to the PrR-negative tumors, the PrR-positive tumors showed significantly smaller maximum, minimum, and mean WTu ADC values (p=0.005, p=0.001, and p<0.001, respectively). In the comparisons of the molecular subtypes in terms of ADCcV, the p-values indicated statistically significant differences between the luminal A (lumA) group and the triple negative (TN) group, between the luminal B (lumB) group and the TN group, and between the Her2-enriched and TN groups (p<0.001, p=0.011, and p=0.004, respectively). Considering the luminal and non-luminal groups, while a significant difference was observed between the groups considering their minimum, maximum, and mean WTu ADC values, their ADCcV values were similar (p<0.001, p=0.004, and p<0.001, respectively).
ConclusionUsing ADCcV in addition to ADC parameters increased the diagnostic power of diffusion weighted-MRI (DW-MRI) in the distinction of molecular subtypes of breast cancer.
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A Preliminary Study of Brain Functional Magnetic Resonance Imaging in Text Reading and Comprehension
Authors: Qi Xie, Huixian Chen, Wenjuan He, Zhilin Tan, Yajie Wang and Yanhui LiaoBackgroundFew studies have focused on the changes in human brain function activities caused by reading Chinese characters with different intelligibility and whether it can reflect the understanding and cognitive ability of the human brain.
ObjectiveTask-fMRI based on Chinese character reading tasks with different intelligibility was used to explore activated brain regions and their cognitive changes.
MethodsVolunteers were randomly recruited using advertisements. Forty volunteers were recruited based on strict inclusion and exclusion criteria, and 40 volunteers were recruited. Brain function data of 40 healthy right-handed volunteers in fuzzy/clear Chinese reading tasks were collected using a Siemens Skyra 3.0T magnetic resonance scanner. Data were preprocessed and statistically analyzed using the statistical software SPM12.0 to observe the activation of the cortex and analyze its characteristics and possible changes in cognitive function.
ResultsTask-fMRI analysis: (1) The main brain regions activated in fuzzy/clear reading tasks were located in the occipital visual cortex (P < 0.001); (2) a paired sample t-test suggested that there was a significant difference in BOLD signals in the brain regions activated by fuzzy/clear reading tasks (P < 0.001, equiv Z = 4.25). Compared with the fuzzy reading task, the brain regions more strongly activated in the clear reading task were mainly located in the right superior frontal gyrus and the bilateral temporal lobe. Compared with the clear reading task, the brain region that was more strongly activated in the fuzzy reading task was mainly located in the right fusiform gyrus.
ConclusionClear Chinese character information mainly activates the dorsal stream of the visual-spatial network. This reflects the information transmission of the brain after understanding the text content and is responsible for guiding and controlling attention. Fuzzy words that cannot provide clear text content activate the fusiform gyrus of the ventral stream of the visual-spatial network, strengthening the function of orthographic processing.
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GastroNet: A Custom Deep Learning Approach for Classification of Anomalies in Gastrointestinal Endoscopy Images
Authors: Anitha Mary. A., Peniel Winifred Raj A., C. Karthik and Aldrin KarunaharanIntroductionAmong all cancer forms, gastrointestinal (GI) cancer is the most serious condition that spreads quickly and requires early detection. GI disorders claim the lives of up to nearly two million people worldwide. To lower the mortality rate from GI cancer, early detection is essential.
MethodsFor the identification of GI illnesses, such as polyps, stomach ulcers, and bleeding, endoscopy is the gold standard in the medical imaging industry. The numerous images produced by endoscopy require an enormous amount of time for the specialist to diagnose the disease. It makes manual diagnosis difficult and has sparked research on automatic computer-based approaches to diagnose all the generated images quickly and accurately. AI-based algorithms have already been used in endoscopy images with promising outcomes and have enhanced disease identification and classification with precision. However, there are still a lot of issues to be solved, including figuring out potential biases in algorithms and improving interpretability and generalizability.
ResultsThe proposed GastroNet model creates a system for classifying digestive problems for the Kvasir Version 1 dataset. The framework consists of different CNN layers with multiple filters, and average max-pooling is used to extract image features. The optimization of network parameters is done using the Stochastic Gradient Descent (SGD) algorithm.
ConclusionFinally, the robustness of the proposed model is compared with other state-of-the-art models like VGG 19, ResNet 50, Inception, and Xception in terms of evaluation metrics.
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Comparative Study of CT and MR Guided Microwave Ablation in the Treatment of Para-vascular VX2 Liver Tumor Model in Rabbits
Authors: Ren Ziwang, Feng Guiling, Feng Xu, Liu Zhu, Li Bing and Du YongObjectiveTo analyze the efficacy of microwave ablation (MWA) guided by computed tomography (CT) and 1.5T magnetic resonance (MR) in the treatment of VX2 para-vascular liver tumor model in rabbits.
Materials and MethodsSixty para-vascular VX2 liver tumor models in rabbits were randomly divided into CT-guided microwave ablation group (CT group, n=35) and MR-guided microwave ablation group (MR group, n=35). The complete ablation rate, mean operation time, postoperative complication rate and mean survival time were compared between the two groups.
ResultsIn the CT group, the rate of complete ablation was 68.6% (24/35), and the mean operation time was 42.1 ± 9.7 minutes. Three cases had ascites and one case had abdominal wall injury. In the MR group, the rate of complete ablation was 94.2% (33/35), and the mean operation time was 53.4 ± 10.9 minutes. One case was complicated with ascites. No serious complications such as pneumothorax, liver abscess, pleural effusion and diaphragm perforation were found in both groups. Between the two groups, the difference in complete ablation rate was statistically significant (P=0.006 < 0.05). A statistically significant difference can also be found in mean operation time (P < 0.01). The follow-up time was 21 days after the operation. As for the postoperative complication rate (11.4% in the CT group and 2.9% in the MR group, P=0.353) and mean survival time (16.9 ± 1.8 days in CT group, 18.3 ± 2.3 days in the MR group, P=0.925), the differences were not statistically significant.
ConclusionCompared with CT guidance, although the microwave ablation time under MR guidance was longer, the complete ablation rate under MR guidance was high, which proved that MR guidance was a more effective way of microwave ablation guidance and was worth promoting in the clinic. In this experiment, the postoperative complication rate was lower in the MR group, although the difference was not statistically significant, which may be related to the small sample size, and the subsequent study on the postoperative complication rate can increase the sample content.
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Assessment of Diagnostic Performance of Risk Factors Affecting Extraprostatic Extension: Role of Zonal Level of Prostate Cancer
Authors: Seo Young Park and Ga young JeonObjectiveExtraprostatic extension (EPE) serves as a crucial marker of prostate cancer aggressiveness and independently predicts the likelihood of biochemical recurrence (BCR), exhibiting a strong correlation with the histologic severity of EPE. Therefore, this study aimed to investigate the probability of EPE along the zonal level of the prostate by measuring tumor contact length (TCL) using multiparametric magnetic resonance imaging (mpMRI).
Patients and MethodsRecords of 308 patients who had undergone radical prostatectomy (RP) were identified. Tumor levels in the prostate were categorized as apex, mid-gland, and base, after which the correlation between TCL measured using MRI and microscopic EPE on pathologic specimens was evaluated. Univariable and multivariable logistic regression analyses were performed to assess the association among tumor origin, index tumor diameter, and TCL measured using MRI and microscopic EPE in RP specimens.
ResultsAmong the 214 patients included, 45 apical cancers (21%), 87 mid-gland cancers (41%), and 82 base cancers (38%) were observed. Pathological reports revealed that 18 (40.0%) apex, 31 (35.6%) mid-gland, and 50 (61.0%) base tumors were pT3a. Multivariable analysis demonstrated that the zonal level of the tumor, especially the base level, was an independent predictive factor for EPE (P < 0.001), and the AUC value of the base tumor was 0.858.
ConclusionProstate cancers arising from the base were more likely to exhibit EPE than those arising from the mid-gland and apex of the prostate gland. Therefore, identifying the origin of the zonal level of prostate cancer may help guide treatment decisions and predict clinical prognosis.
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Automatic Kidney Stone Composition Analysis Method Based on Dual-energy CT
Authors: Jianping Huang, Jiachen Hou, Weihong Yang, Meixiao Zhan, Shengfu Xie, Shuping Li, Ru Li, Shangxin Wu, Yuan He, Wei Zhao, Rui Zhang, Ge Shan and Wenjun NiBackgroundThe composition of kidney stones is related to the hardness of the stones. Knowing the composition of the stones before surgery can help plan the laser power and operation time of percutaneous nephroscopic surgery. Moreover, patients can be treated with medications if the kidney stone is compounded by uric acid before treatment, which can relieve the patients of the pain of surgery. However, although the literature generally reports the kidney stone composition analysis method base on dual-energy CT images, the accuracy of these methods is not enough; they need manual delineation of the kidney stone location, and these methods cannot analyze mixed composition kidney stones.
ObjectiveThis study aimed to overcome the problem related to identifying kidney stone composition; we need an accurate method to analyze the composition of kidney stones.
MethodsIn this paper, we proposed the automatic kidney stone composition analysis algorithm based on a dual-energy CT image. The algorithm first segmented the kidney stone mask by deep learning model, then analyzed the composition of each stone by machine learning model.
ResultsThe experimental results indicate that the proposed algorithm can segment kidney stones accurately (AUC=0.96) and predict kidney stone composition accurately (mean Acc=0.86, mean Se=0.75, mean Sp=0.9, mean F1=0.75, mean AUC=0.83, MR (Exact match ratio)=0.6).
ConclusionThe proposed method can predict the composition and location of kidney stones, which can guide its treatment.
Experimental results show that the weighting strategy can improve kidney stone segmentation performance. In addition, the multi-label classification model can predict kidney stone composition precisely, including the mixed composition kidney stones.
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TIPS with a Twist – The Real Life Management of a Case of Budd-Chiari-related Acute Liver and Subsequent Multiple Organ Failure
Authors: Rareș Crăciun, Romeo Chira, Andrada Nemes, Horia Ștefănescu, Simona Cocu and Bogdan ProcopețIntroductionBudd-Chari syndrome (BCS) is a rare condition defined by the obstruction of hepatic venous outflow. BCS is a relatively infrequent cause of acute liver failure (ALF), accounting for less than 1% of cases. Treatment for acute BCS consists of a stepwise approach, requiring anticoagulation, angioplasty, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation.
Case ReportWe present the case of a 31-year-old female patient with BCS, which led to ALF and subsequent multiple organ failure, which was successfully treated with TIPS and endovascular coil placement. Initial diagnostic workup revealed the complete obstruction of the hepatic venous outflow, spleno-mesenteric confluent thrombosis, and biochemical criteria of ALF. Her condition rapidly deteriorated towards multiple organ failure. At one point, the MELD score was 42, while the SOFA score predicted a mortality rate of >95%. Following continuous venovenous hemodiafiltration with cytokine adsorbent filters, TIPS was inserted, resulting in a portal pressure gradient (PPG) of 14 mmHg. Following TIPS, the patient had persistent ascites and later presented an episode of gastric variceal bleeding with endoscopic and surgical treatment failure. TIPS revision with further dilation led to a final PPG of 6 mmHg. During the procedure, selective embolization by coil placement of the spleno-gastric collateral circulation ultimately resolved the variceal bleeding. In the aftermath, the patient had complete organ failure remission and was successfully discharged with no ascites, encephalopathy, or significant impairment regarding daily life activities.
ConclusionIn the rare setting of BCS complicated with ALF and portal hypertension-related complications, TIPS and endovascular embolization provide a unique, effective, and against-all-odd solution.
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Establishment and Comparison of Piecewise Linear Regression Models to Measure Thyroid Volume by 2D and 3D Ultrasound
Authors: Yue-Gui Wang, Shu-Ping Yang, Ming-Yong Cai, Ke-Yue Chen, Ting-Ting Li and Hao-Lin ShenObjectiveCompared thyroid volumes measured by 2-D and 3-D US with those of resected specimens and proposed new models to improve measurement accuracy.
MethodsThis study included 80 patients who underwent total thyroidectomy. One 2D_model and one 3D_model were developed using piecewise linear regression analysis. The accuracy of these models was compared using an ellipsoid model (2-D_US value × 0.5), 3-D_US value, and Ying’s model [1.76 + (2-D_US value × 0.38)].
ResultsThe new 2D_model was: V=2.66 + (0.71 * X1) - (1.51 * X2). In this model, if 2-D_US value <= 228.39, X1 = 2-D_US value and X2 = 0; otherwise, X1 = 2-D_US value and X2 = 2-D_US value - 228.39. The 3D_model was: V= 2.90 + (1.08 * X1) + (2.43 * X2). In this model, if 3-D_US value <= 102.06, X1 = 3-D_US value and X2 = 0; otherwise, X1 = 3-D_US value and X2 = 3-D_US value - 102.06. The accuracy of the new models was higher than that of the 3-D_US value, the ellipsoid model, and Ying’s model (P<0.05).
ConclusionThe models established are more accurate than the traditional ones and can accurately measure thyroid volume.
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Assembling High-quality Lymph Node Clinical Target Volumes for Cervical Cancer Radiotherapy using a Deep Learning-based Approach
Authors: Xiaoxuan Jiang, Shengyuan Zhang, Yuchuan Fu, Hang Yu, Huanan Tang and Xiangyang WuAimThe study aimed to explore an approach for accurately assembling high-quality lymph node clinical target volumes (CTV) on CT images in cervical cancer radiotherapy with the encoder-decoder 3D network.
Methods216 cases of CT images treated at our center between 2017 and 2020 were included as a sample, which were divided into two cohorts, including 152 cases and 64 cases, respectively. Para-aortic lymph node, common iliac, external iliac, internal iliac, obturator, presacral, and groin nodal regions were delineated as sub-CTV manually in the cohort including 152 cases. Then, the 152 cases were randomly divided into training (96 cases), validation (36 cases), and test (20 cases) groups for the training process. Each structure was individually trained and optimized through a deep learning model. An additional 64 cases with 6 different clinical conditions were taken as examples to verify the feasibility of CTV generation based on our model. Dice similarity coefficient (DSC) and Hausdorff distance (HD) metrics were both used for quantitative evaluation.
ResultsComparing auto-segmentation results to ground truth, the mean DSC value/HD was 0.838/7.7mm, 0.853/4.7mm, 0.855/4.7mm, 0.844/4.7mm, 0.784/5.2mm, 0.826/4.8mm and 0.874/4.8mm for CTV_PAN, CTV_common iliac, CTV_internal iliac, CTV_external iliac, CTV_obturator, CTV_presacral, and CTV_groin, respectively. The similarity comparison results of six different clinical situations were 0.877/4.4mm, 0.879/4.6mm, 0.881/4.2mm, 0.882/4.3mm, 0.872/6.0mm, and 0.875/4.9mm for DSC value/HD, respectively.
ConclusionWe have developed a deep learning-based approach to segmenting lymph node sub-regions automatically and assembling high-quality CTVs according to clinical needs in cervical cancer radiotherapy. This work can increase the efficiency of the process of cervical cancer detection and treatment.
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Application of Color Doppler Ultrasound to Evaluate and Analyze the Risk Factors of Residual Stenosis after Vertebral Artery Origin Stenting
Authors: Yue Han, Xi-ping Mo, Xin-yue Ge and Jian-yuan HuangBackground: Vertebral artery origin stenting (VAOS) is the mainstream method for the treatment of vertebral artery stenosis (VAS). However, there are few studies on the risk factors analysis for residual stenosis after VAOS.
Purpose: This study aimed to apply color Doppler ultrasound (CDU) to evaluate and analyze the risk factors of residual stenosis after VAOS.
Methods: About 178 patients with VAOS were included from 2017 to 2019 in Liuzhou worker’s hospital and divided into the residual stenosis group (n = 38) and the no-residual stenosis group (n = 140). The clinical data and hemodynamics alteration before and after VAOS were collected. The univariate and multivariate logistic regression analysis was used to analyze the risk factors of residual stenosis.
Results: Compared with the no-residual stenosis group, the proportion of hypertension, the bending of the initial segment, and the residual stenosis length > 10 mm in the residual stenosis group were significantly higher, while the original internal diameter was significantly smaller (P < 0.05). The multivariate logistic regression analysis showed that the bending of initial segment (OR = 2.41, 95% CI: 1.32-5.45, P = 0.033), the original internal diameter (OR = 2.29, 95% CI: 1.13-5.66, P = 0.001), and the residual stenosis length > 10 mm were the risk factors of residual stenosis (OR = 2.78, 95% CI: 1.82-5.85, P = 0.044).
Conclusion: The bending of initial segment, the original internal diameter, and the residual stenosis length > 10 mm were the risk factors of residual stenosis after VAOS.
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Automatic Detection and Segmentation of Brain Hemorrhage based on Improved U-Net Model
Authors: Thuong-Cang Phan and Anh-Cang PhanIntroduction: Brain hemorrhage is one of the leading causes of death due to the sudden rupture of a blood vessel in the brain, resulting in bleeding in the brain parenchyma. The early detection and segmentation of brain damage are extremely important for prompt treatment.
Methods: Some previous studies focused on localizing cerebral hemorrhage based on bounding boxes without specifying specific damage regions. However, in practice, doctors need to detect and segment the hemorrhage area more accurately. In this paper, we propose a method for automatic brain hemorrhage detection and segmentation using the proposed network models, which are improved from the U-Net by changing its backbone with typical feature extraction networks, i.e., DenseNet-121, ResNet-50, and MobileNet-V2. The U-Net architecture has many outstanding advantages.
Results: It does not need to do too many preprocessing techniques on the original images and it can be trained with a small dataset providing low error segmentation in medical images. We use the transfer learning approach with the head CT dataset gathered on Kaggle including two classes, bleeding and non-bleeding.
Conclusion: Besides, we give some comparison results between the proposed models and the previous works to provide an overview of the suitable model for cerebral CT images. On the head CT dataset, our proposed models achieve a segmentation accuracy of up to 99%.
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- Medicine, Imaging, Radiology, Nuclear Medicine
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Can Uterine Artery Pulsatility Index Predict Fetal Chromosomal Abnormality in Early Pregnancy Loss? A Retrospective Cohort Study
Authors: Yunyun Cao, Yiyao Chen, Guanjie Wang, Shuyuan Li and Zhiwei LiuBackgroundEarly pregnancy loss (EPL) or spontaneous loss of an intrauterine pregnancy within the first trimester occurs commonly worldwide. It is useful to predict the possibility of fetal chromosomal abnormalities using other cheap and easily available markers.
ObjectiveThis study aimed to evaluate whether the uterine artery pulsatility index (UtA-PI) can predict fetal chromosomal abnormality in early pregnancy loss (EPL).
MethodsThis was a retrospective cohort study including 148 women who underwent dilation and curettage for missed abortion. The UtA-PI was measured and evaluated by transvaginal ultrasound. Abnormal UtA-PI was identified through the mean of left and right UA-PI ≥ 90th percentiles of the relevant values for the corresponding gestational age. Copy number variation sequencing (CNV-seq) was performed on EPL cases without maternal cell contamination.
Results107 (72.3%) cases were classified with normal UtA-PI, while 41 (27.7%) cases were classified with abnormal UtA-PI. The fetal chromosomal abnormality rate was significantly higher in cases with normal UtA-PI than in those with abnormal UtA-PI (67.3% vs 22.0%, P = 7.1 × 10-7). Compared to cases with abnormal UtA-PI, the risk of fetal chromosomal abnormalities in cases with normal UtA-PI increased with an odds ratio of 7.3 (95% confidence interval [CI]: 3.2‒17.0, P = 4 × 10-7). The predictive value of normal UtA-PI alone for fetal chromosomal abnormalities was shown to have an area under the curve of 0.67‒0.71 in our population.
ConclusionThe UtA-PI seems to be lower and less likely to be elevated in EPL with fetal chromosomal abnormalities compared to those without aneuploidies. We suggest that UtA-PI should be examined in all EPL patients.
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Rare and First Manifestation of Lupus Panniculitis as Lupus Mastitis: A Case Report and Literature Review
Authors: Chong Yong Guo, Li Chen, Lin Sun, Xiao Shan Yang, Ruiqi Mao, Bo Cheng Li, Xin Jun Li and Ling ZhouIntroductionThis case report presents a rare occurrence of lupus mastitis affecting the breast.
Case PresentationAn induration with mild discomfort was detected in the upper inner quadrant of the right breast of a 27-year-old Chinese woman with regular menstrual cycles. The patient is currently unmarried and has no previous history of full-term pregnancies or lactation. An ill-defined, subcutaneous, hyperechoic lesion with no calcification was visualized on breast ultrasound. Peripheral and internal blood flow signals demonstrated high intensity. Pathological analysis of a breast needle biopsy revealed fat lobule necrosis accompanied by mixed lymphoplasmacytic and histiocytic aggregates.
ConclusionThe diagnosis of lupus mastitis necessitates a comprehensive evaluation of the patient's medical history, serological testing, imaging studies, and histopathological analysis.
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Gastric Teratoma in an Adult Female Patient: A Case Report
Authors: Savaş Hereklioğlu, Derya Karabulut, Gülşah Özdemir, Ebru Taştekin and Nermin TunçbilekBackgroundGastric teratoma (GT) occurs as a rule in infancy and is an extremely unusual gastric tumor in adult patients.
Case PresentationIn this paper, we present the clinical and imaging findings of a 56-year-old female patient with a GT. The patient's main symptoms were increasing abdominal discomfort and pain. After the physical examination, she underwent ultrasound (US) and computed tomography (CT), which showed a large mass at the posterior wall of the stomach, and a teratoma was initially considered. After surgery, pathology confirmed the diagnosis of GT. The patient recovered after surgery and was discharged in good health. To the best of our knowledge, this study is the first reported case of gastric teratoma in an adult woman in the literature.
ConclusionGastric teratoma of the adult period is a rare benign neoplasm that may have several complications; therefore, imaging is crucial for diagnosis and accurate treatment management. The aim of this study is to emphasize the value of US and CT in the diagnosis and treatment monitoring of mature gastric teratomas.
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Intrapancreatic Accessory Spleen Diagnosed by Size Reduction after Immunosuppressive Therapy: A Case Report
Authors: Turgut Tursem Tokmak, Mahmut Burak Lacin and Humeyra GencerBackgroundIntrapancreatic accessory spleen (IPAS) is a congenital entity that can be confused with malignant distal pancreatic masses. Radiologic imaging and radionuclide imaging have an important place in the diagnosis of IPAS.
Case ReportBlood tests were performed on a 36-year-old female patient who presented with tachypnea, tachycardia, pain in the joints, and pain in the left abdominal quadrant. Laboratory test results were as follows: hemoglobin value 6.0 mg/dl, sedimentation 120, aspartate transaminase (AST) 150U/L, and alanine transaminase level (ALT) 110U/ L. Additional laboratory tests and ultrasonography were performed. The anti-double-stranded DNA (dsDNA) level was 800 IU/ml. C3 and C4 values were both 0.64 IU/ml, with anti-Ro-52 +++(three positive) and anti-Ro-60 ++ (two positive). A clinical diagnosis of systemic lupus erythematosus (SLE) was made. Ultrasonography and dynamic contrast-enhanced upper abdominal MRI showed lesions suggestive of multiple hemangiomas in the liver and a 29x18 mm lesion in the tail of the pancreas with a similar appearance as the spleen. SLE treatment was started. Scintigraphy was recommended for the diagnosis of IPAS. Scintigraphy was performed in the third week of the treatment. Uptake was not observed. In the second month of the treatment, a control upper abdominal MRI was performed, and a decrease in the size of the lesion was observed.
ConclusionIPAS can be confused with pancreatic masses. Lack of uptake in scintigraphy may be due to treatment protocols that produce low phagocytic activity. If radiological imaging findings are compatible, a reduction in lesion size after immunosuppressive therapy can be accepted as evidence for the diagnosis of IPAS.
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Gd-EOB-DTPA-enhanced Magnetic Resonance Imaging Combined with T1 Mapping Identifies Dysplastic Module and Hepatocellular Carcinoma: A Retrospective Study
Authors: Diyou Chen, Qisheng Ran, Wei Ma, Huan Xie, Jie Zhou, Ji Liu, Yuanyuan Zhao, Letian Zhang and Yu GuoBackgroundHepatocellular carcinoma (HCC) is the leading type of liver cancer in adults, often resulting in fatal outcomes for those with cirrhosis. Dysplastic nodule (DN) is a liver nodule that is substantial in size, ranging from 1-2 cm. However, accurately distinguishing between DN and HCC on imaging has posed a challenge.
ObjectiveThe aim of this study is to assess the usefulness of Gd-EOB-DTPA-enhanced MRI T1 mapping in distinguishing between DN and HCC.
MethodsThis study analyzed 66 patients with confirmed HCC or DN who underwent Gd-EOB-DTPA-enhanced MRI T1 mapping before surgery or puncture at the Army Medical Center in China. The T1 values of each lesion were measured before and after Gd-EOB-DTPA administration, and various calculations were made, including absolute and percentage reduction in T1 value and coefficient of variation. The t-test was used to compare these values between the two groups, and the efficacy of T1 mapping values for differential diagnosis of HCC and DN was evaluated using the receiver operating characteristic curve (ROC).
ResultsThe study found that T1pre, T1hp, ΔT1, ΔT1%, and CV in the HCC group were significantly higher than in the DN group (p < 0.01). The accuracy of T1hp, ΔT1, and CVT1-hp in identifying HCC from DN was high, with AUCs of 0.955, 0.910, and 0.932, respectively. ΔT1% also had some accuracy, with an AUC of 0.818.
ConclusionOur results provide preliminary evidence that Gd-EOB-DTPA-enhanced MRI T1 mapping, can be a valuable tool in diagnosing and differentiating between HCC and DN.
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Diagnostic Value of 3D Optical Coherence Tomography Multimode Images in the Diagnosis of Acute Central Serous Chorioretinopathy
Authors: Gui-ling Zhao, Rui-zhuang Li, Yan-hua Pang, Xiu-qin Wang, Jin-fen Wei and Zhou ZhouBackgroundSpectral-Domain Optical Coherence Tomography (SD-OCT) provides non-invasive, high-speed, high-resolution, three-dimensional cross-section imaging of the macula.
ObjectivesThis study aimed to investigate the diagnostic value of the multimodal imaging technique of three-dimension (3D) optical coherence tomography (OCT) (3D-OCT) for the diagnosis and characterization of acute central serous chorioretinopathy (CSC).
MethodsIn this prospective clinical study 3D-OCT examinations of 82 cases with acute CSC were performed on the macular area, and the image characteristics were analyzed. Our study included a total of 87 eyes from 82 cases of CSC patients, 67 males and 15 females (mean age ± standard deviation (SD): 42.89 ±7.80 years old; age range: 27 to 56 years old. The 3D-OCT images were evaluated for the presence of subretinal fluid, subretinal space, fluctuation of the internal limiting membrane (ILM), folds of retinal pigment epithelial (RPE), retinal pigment epithelium detachment (PED), and flat irregular PED. The foveal thickness was measured using the manual caliper of OCT software.
ResultsThe OCT B-scan images showed 87 (100%) eyes had exudative retinal detachment (ERD), 38 (44%) had flat irregular PED, 36 (41%) had PED, 8 (9%) had subretinal turbidity structure, 2 (2%) had subretinal dot-like precipitates, 1 (1%) had focal choroidal excavation (FCE), and 1 (1%) eye had fluctuation of internal limiting membrane (FI). In the ILM-RPE thickness map, all eyes had a round or round like regular uniform domes. Fifty-seven (66%) domes were limited in the examination area and 30 (44%) domes were beyond the scope of this examination and only a partial section of the dome could be observed. In the en-face image, all eyes had a round or round-like black figure that corresponded with domes in the ILM-RPE thickness map. In RPE surface, 76 (87%) eyes had a shallow plate depression, 71(82%) had small focal uplift, and 1 (1%) eye had a focal concave feature.
ConclusionIn the OCT ILM-RPE thickness, en-face image, and RPE surface maps, acute CSC exhibited specific imaging characteristics that can be helpful for reliable diagnosis and differential diagnosis of CSC.
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Relationship of the Characteristic Imaging Findings of Breast Cancer with Molecular Subtypes in Young Women
Authors: Emirhan Temel, Eda Elverici, Engin Sarı, Arzu Özsoy, Mutlu Akbaş Doğan and Sezer KulaçoğluBackgroundThe characteristic imaging findings of breast cancer in young women are not yet fully understood. It causes a delay in diagnosis by mixing with benign findings.
ObjectiveTo evaluate the relationship between the imaging and histopathological features of breast cancer in women aged under 40 years.
MethodsIn our center, 537 suspicious lesions were detected in a total of 15,223 adult female patients under 40 years who were evaluated by breast ultrasonography (US). As a result of the mammographic, histopathological, and immunohistochemical analysis, 101 lesions meeting the study criteria were included in the sample.
ResultsThe luminal subtypes of breast cancer mostly visualized as irregularly shaped spiculated lesions with calcification and architectural distortion mammography and presented as masses that were sometimes accompanied by increased echogenicity in the surrounding tissue on US. The human epidermal growth factor receptor 2 (HER2) enriched subtypes mostly had microlobulated or indistinct margins with heterogeneous echoes accompanied by high calcification on mammography. The triple-negative (TN) subtypes generally appeared as microlobulated lesions with angular or indistinct margins, hypo echogenicity, posterior enhancement or shadowing, and vascularization.
ConclusionSome radiological features of breast cancer in young women were found to be associated with molecular subtypes similar to other age groups in the literature. However, unlike other age groups, the incidences of the HER2-enriched subtype presenting with only calcification, TN subtypes presenting with circumscribed masses, and calcification were found to be low among the young women in our study.
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MDCT Imaging of Volvulus Complicated with Acute Mesenteric Ischemia Secondary to a Large Diverticulum of Jejunum in an Adult: A Case Report and Literature Review
Authors: Yan Lei, Zhi-chun Li, Ting-ting Zhu, Qian He, Yong Li and Wei TangIntroductionA large jejunal diverticulum has been reported as a possible cause of volvulus and acute mesenteric ischemia (AMI) in adults. A large diverticulum of the small bowel complicated with volvulus has been reported before in literature. However, imaging findings of a large diverticulum of the small bowel complicated with both volvulus and AMI on MDCT are rarely described and reported. In this study, we reported a case with a large diverticulum, volvulus, and AMI concurrently; these three imaging findings were reviewed and described on MDCT, and the relevant literature was briefly introduced.
Case ReportWe reported the case of a 69-year-old man who presented to our hospital with acute abdominal pain and vomiting. An emergent abdominal enhanced MDCT imaging was performed and demonstrated the volvulus secondary to a large diverticulum of the jejunum complicated with AMI. Here, a case was presented that highlighted unique imaging findings on MDCT, as well as a literature review.
ConclusionA review of the literature revealed that a single jejunal diverticulum causing both volvulus and AMI is rare in adults. To our knowledge, a systemic description of their signs on MDCT in a case has not been reported yet.
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The Role of MRI in Diagnosing Agenesis of the Corpus Callosum (ACC): A Rare Disorder Present at Birth
Authors: Alhassan Alkurim, Jaber Alyami, Njoud Aldusary and Adnan AlahmadiBackgroundAgenesis of the corpus callosum (ACC) is a rare hereditary nervous system defect present at birth. ACC is an uncommon condition that is unrepresentative in the general population because some cases do not present with any identifiable symptoms in the early stage.
Case ReportWe present a case of ACC in a two-month-old male patient who was diagnosed after birth. Although the initial brain ultrasound (US) showed dilation of the lateral ventricles and the absence of the corpus callosum, these findings were not fully confirmed. Therefore, magnetic resonance imaging (MRI) of the brain was conducted to confirm the complex diagnosis, and the examination revealed complete ACC. Diagnosing ACC in a neonate demonstrates the complexity of diagnosis through the clinical presentation, especially at an early age.
ConclusionThe clinical utility of neonatal US and MRI highlights the importance of an early diagnosis of ACC. MRI is more effective than the US in detecting this condition, and these imaging modalities provide the patient with an early diagnosis, which helps in treatment management.
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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)