Current Medical Imaging - Current Issue

Cerebral microbleeds (CMBs) are commonly present in patients with hypertension, producing iron-containing metabolites. A small amount of regional iron deposition is hardly discernible on conventional magnetic resonance imaging (MRI). Three-dimensional enhanced susceptibility-weighted angiography (ESWAN) provides tissue images with high spatial resolution and signal-noise ratio, and has been widely used to measure brain iron deposition in neurodegenerative diseases and intracranial hemorrhage.

The study aimed to demonstrate iron deposition in the brain of hypertensive patients using ESWAN.

Twenty-seven hypertension patients, with or without CMBs, and 16 matched healthy controls (HCs) were enrolled. From the post-processed ESWAN images, phase and magnitude values of the regions of interest (ROIs) were calculated. Two-sample t-test and one-way variance analysis were applied to compare groups. The relationship between ESWAN parameters and clinical variables was assessed using Pearson’s correlation coefficient.

Compared to HCs, the phase value of the hippocampus, head of caudate nucleus (HCN), and substantia nigra (SN) was decreased in hypertension with the CMBs subgroup, while that of HCN and SN was decreased in hypertension without CMBs subgroup. Similarly, the magnitude value of the hippocampus, HCN, thalamus red nucleus, and SN was significantly lower in the hypertension group than HCs. In addition, the phase and magnitude values showed a correlation with clinical variables, including disease duration and blood pressure.

Deep grey matter nuclei displayed greater iron content in hypertension patients. Iron deposition may precede the appearance of CMBs on MRI, serving as a potential marker of microvascular damage.

The quantitative measure of dopamine transporter (DaT) in the human midbrain is generally used as a biomarker for analyzing Parkinson’s disease (PD).

DaT scan images or Single- photon emission computed tomography (SPECT) images are utilized to capture the dopamine content more accurately.

Only sixteen slices out of ninety-one of SPECT images were chosen on the basis of the high amount of dopamine content and were named Volume rendering image slices (VRIS). This paper proposes a novel Convolutional Neural Network (CNN) called JAN Net which particularly treats the VRIS for identifying PD. The JAN Net preserves the edges and spatial features of the striatum by using a modified exigent feature (M-ExFeat) block, that contains convolutional and additive layer. The different-sized convolutional layer extracts both low- and high-level features of Striatum. The additive layer adds up all the features of different filter sized convolutional layers like 1x1, 3x3, and 5x5. The added output features are used to improve the learnability of neurons in the hidden layer. The network performance is tested for stride 1 and stride 2.

The results are validated using the dataset taken from the Parkinson’s Progression Markers Initiative (PPMI) database. The JAN Net ensures improved performance in terms of accuracy. The training and validation accuracy for stride 2 is 100% with minimum losses. The outcome has been compared with different deep learning architectures and the machine learning techniques like Extreme Learning Machines (ELM), and Artificial Neural Networks (ANN) to highlight the efficacy of the proposed architecture.

Hence, the present work could be of great aid to the experts in neurology to protect the neurons from impairment.

Arthritis of the hip caused by arteriovenous malformations (AVMs) has been rarely reported. Therefore, total hip replacement (THR) in patients with AVM-induced arthritis of the hip is challenging.

We report a 44-year-old woman with aggravated right hip pain during the past decade. The patient presented with severe pain and a functional disorder of the right hip. X-ray examination revealed severely narrowed right hip joint space and abnormal trabecular bone loss in the femoral neck and trochanter area. Doppler ultrasound, magnetic resonance imaging and computed tomography angiography revealed AVMs surrounding the right hip, along with erosion. To ensure the safety of THR, we performed vascular embolization and temporary balloon occlusion of the iliac artery three times during the operation. However, serious hemorrhage occurred, which was rescued by the multimodality blood conservation strategy. THR was successfully performed, and the patient was discharged 8 d later for rehabilitation. Postoperative pathological examination showed osteonecrosis of the femoral head with malformed thick-walled vessels and focal granulomatous inflammation of the surrounding soft tissues. The Harris Hip Scale score increased from 31 to 82 at 3 mo of follow-up. The patient was followed up for 1 year, and all her clinical symptoms were significantly alleviated.

Arthritis of the hip caused by AVMs is rare in clinical practice. The activity and function of the involved hip joint can be effectively treated with THR after comprehensive imaging and multidisciplinary consultation.

Arthritis of the hip caused by arteriovenous malformations is rarely reported. Total hip replacement (THR) is a reliable and effective option for the treatment of advanced arthritis of the hip. We report a 44-year-old woman with aggravated pain in the right hip during the past decade. With the vascular intervention and multimodality blood conservation strategy. THR can be successfully performed in patients with AVM-induced arthritis of the hip.

Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is a rare tumor that arises in the myometrium of the uterus. It is regarded as an intermediate malignant tumor according to the recent World Health Organization classification. Few studies have reported the radiologic findings of STUMP, and the differentiation of STUMP from leiomyoma remains controversial.

A 42-year-old nulliparous female presented at our institution with massive vaginal bleeding. Radiological studies, including ultrasonography, computed tomography (CT), and magnetic resonance imaging, revealed an oval-shaped mass with well-defined margins in the uterus protruding into the vagina. The patient underwent a total abdominal hysterectomy, and the final pathology was confirmed as STUMP.

Distinguishing STUMP from leiomyomas based solely on radiological findings can be challenging. However, if the uterine mass appears as a single mass lacking acoustic shadowing on ultrasound and demonstrates diffusion restriction with high T2 signal intensity on magnetic resonance imaging, consideration of STUMP may be necessary for proper patient management, given the poor prognosis associated with this tumor.

With the advancement of computer and medical imaging technologies, a number of high-resolution, voxel-based, full-body human anatomical models have been developed for medical education, industrial design, and physics simulation studies. However, these models are limited in many applications because they are often only in an upstanding posture.

To quickly develop multi-pose human models for different applications. A semi-automatic framework for voxel deformation is proposed in the study.

This paper describes a framework for human pose deformation based on three-dimensional (3D) medical images. The voxel model is first converted into a surface model using a surface reconstruction algorithm. Second, a deformation skeleton based on human bones is defined, and the surface model is bound to the skeleton. The bone Glow algorithm is used to assign weights to the surface vertices. Then, the model is deformed to the target posture by using the Smoothed Rotation Enhanced As-Rigid-As-Possible (SR-ARAP) algorithm. Finally, the volume-filling algorithm is applied to refill the tissues into the deformed surface model.

The proposed framework is used to deform two standing human models, and the sitting and running models are developed. The results show that the framework can successfully develop the target pose. When compared to the results of the As-Rigid-As-Possible algorithm, SR-ARAP preserves local tissues better.

The study proposes a frame for voxel human model deformation and improves the local tissue integrity during deformation.

Carbonated beverages and puffed foods are popular among young people during leisure and entertainment. However, there have been a few death cases reported after ingesting large amounts of junk food in a short time.

A 34-year-old woman was admitted to the hospital with acute abdominal pain due to a bad mood and consumption of large amounts of carbonated beverages and puffed foods. Emergency surgery revealed a ruptured dilated stomach combined with severe abdominal infection, and the patient died after the surgery.

We should keep in mind the possibility of gastrointestinal perforation in patients with acute abdomen with a history of heavy consumption of carbonated beverages and puffed foods. We need to evaluate the acute abdomen patients after taking large amounts of carbonated beverages and puffed foods in combination with symptoms, signs, inflammatory indicators, imaging and other examinations, and the possibility of gastric perforation needs to be considered, and emergency repair surgery should be arranged.

This study aimed to assess the response of combretastatin-A4-phosphate (CA4P) in rabbit VX2 liver tumors using intravoxel incoherent motion diffusion-weighted MRI (IVIM DW-MRI).

Forty rabbits with implanted VX2 liver tumors underwent baseline MRI and were then given 10 mg/kg CA4P (n=20) or saline (n=20). After 4 h, 10 rabbits from each group underwent an MRI examination and were then sacrificed. The remaining rabbits underwent MRI after 1, 3, and 7 days and were then sacrificed. Liver samples were processed for H&E and immunohistochemical staining. IVIM parameters (D, f, D*) were compared in the treatment and control groups, and the correlations of IVIM parameters with microvascular density (MVD) were determined.

At 4 h, the two treatment groups had significantly different f and D* values (p<0.001), and these values were at their minimum in the treatment group. The treatment group had moderate correlations between MVD and f at 4 h (r=0.676, p=0.032) and 7 days (r=0.656, p=0.039) and with D* at 4 h (r=0.732, p=0.016) and 7 days (r=0.748, p=0.013), but no correlation was reported between MVD and f or D* in the control group (all P>0.05).

IVIM DW-MRI is a sensitive imaging technique. It successfully evaluated the effect of CA4P on VX2 liver tumors in rabbits. The f and D* values correlated with MVD at 4 h and 7 days after using CA4P, indicating that these parameters have the potential to be used as indicators of tumor angiogenesis after treatment.

To analyze the MRI findings of stage IA ovarian cancer.

The data on age distribution, clinical symptoms at onset, CA125 detection, MRI findings, including tumor volume, structure, diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) and enhancement, etc., of the patients with stage IA ovarian cancer, who were admitted to Nantong tumor Hospital between 2013 and 2020 were analyzed retrospectively.

Only 11 cases of stage IA ovarian cancer were recorded. The age of patients was 30–67 (average 52) years. The initial symptoms were mostly lower abdominal distension and abdominal pain. CA125 was 90% positive. MRI features 1. Large pelvic mass with a volume range of 23–2,009 cm³ (average 669 cm³). 2. Five cases of cyst type (with plaque-like, papillary, or mural nodule vegetations), two cases of cystic-solid mixed type (with thickened septum or wall), and four cases of solid type. 3. DWI diffusion was limited, and ADC was reduced on all solid components (vegetation, septa, and cyst wall). 4. The solid parts were significantly enhanced on T1-enhanced MRI. 5. There was no metastasis in the pelvic cavity, and a few ascites (negative tumor cells) in three patients.

MRI characteristics of stage IA ovarian carcinomas were large tumors; cystic, cystic-solid, or solid; solid parts limited diffusion on DWI and low ADC; enhancement of the cyst wall, vegetation, and septa; no pelvic metastasis.

Imaging studies play a crucial role in diagnosing femoroacetabular impingement (FAI), including plain radiography and Magnetic Resonance Imaging (MRI). FAI is a combined pathology of bony abnormality, labral and labrocartilagenous erosions. Surgical treatment for such cases has become more established and preoperative imaging is the roadmap that includes the assessment of labrum and articular cartilage.

During a period of 2 years, thirty-seven patients with a clinical diagnosis of FAI were retrospectively enrolled in this study, including 17 men and 20 women, aged 27–62 years. There were 22 right hips and 15 left hips. MRI was done for all patients to identify bony details, labral and chondral abnormalities and to exclude coexisting disorders. The imaging findings were compared with the arthroscopic data.

15 patients had Pincer FAI, 11 patients had CAM, and 11 patients had combined Cam/Pincer FAI. Labral tear was detected in 100% of patients, 97% had an anterosuperior labral tear. 82% of patients had partial thickness cartilage lesions and 8% had full thickness cartilage lesions. MRI had a sensitivity of 100% compared to hip arthroscopy in detecting labral tear, 60% in detecting cartilage erosion.

Conventional hip MRI detects bony changes in FAI, type of impingement and associated labral tear and cartilage erosions in comparison to the hip arthroscopy.

Subchondral insufficiency fractures (SIF) of the knee joint are prevalent in osteoporosis patients over the age of 55. Early diagnosis of SIF fracture of the medial femoral condyle is crucial for delaying disease progression, early therapy, and potential disease reversal. Magnetic resonance imaging (MRI) is useful in detecting SIF, which is often undetectable on initial radiographs.

This study aimed at developing a grading system for subchondral insufficiency fractures (SIF) based on MRI to predict outcomes and evaluate risk factors.

In this study, MRI was used to examine SIF risk variables in the medial condyle of the femur to help clinicians diagnose, treat, and delay the condition. A total of 386 patients with SIF from 2019 to 2021 were retrospectively analyzed and divided into 106 patients in the disease group and 280 patients in the control group according to whether they had SIF. The lesion site, meniscus, ligament, and other parameters were evaluated and compared. At the same time, a grading system was introduced to stratify and statistically analyze the size of the lesion area, the degree of bone marrow edema (BME), meniscus tears, and other parameters in the patients.

Most SIF were low-grade (LG) fractures, and the predictors of LG and high-grade (HG) fractures included heel tear (P =0.031), degree of medial malleolus degeneration (P < 0.001), advanced age (P < 0.001), and lesion size (P < 0.001). The prognostic factors that showed significant differences between the two groups included age (P =0.027), gender (P =0.005), side (P =0.005), medial tibial plateau injury (P < 0.0001), femoral medullary bone marrow edema (P < 0.0001), medial tibial plateau bone marrow edema (P < 0.0001), meniscus body partial injury (P =0.016), heel tear (P =0.001), anterior cruciate ligament injury (P =0.002), and medial collateral ligament injury (P < 0.0001).

This current study proposed an MRI-based grading system for inferior condylar fractures of the femur, in which HG inferior condylar fractures are associated with severe medial malleolus degeneration, advanced age, lesion size (correlation), and meniscus heel tears.

The study was conducted on patients who received diagnostic X-rays in King Khalid Hospital (KKH), Majmaah.

The study included the seven most frequently performed investigations, which were carried out on over 1504 patients using digital radiography equipment.

The X-ray tube's output and exposure parameters were used to calculate the effective dose (ED) and patient entry surface air kerma (ESAK). Additionally, based on these results, conversion coefficients were determined. This study also examined the 75th percentile distributions of ESAK and KAP. The findings of this research were compared with the findings of other researchers throughout the country and the world. The study presents the uncertainty U values, as well as the mean ESAK, KAP, and ED values.

The results of the ESAK, KAP, and ED values were 0.12-5.74 mGy, 0.9-1.84 Gy cm², and 0.01-0.23 mSv, respectively. As a result, the dosages were much lower than those previously published for the European DRL, national standards, and other studies.

The study concludes that during dose surveys, the importance of detecting and comprehending radiation doses, as well as the proper technique for taking the finest photos possible, can be emphasized to patients in order to assist them in avoiding radioactive particles and radiation exposure.

The combination of FFDM and DBT can significantly improve the diagnostic efficiency of breast cancer, but with the increase of breast radiation absorbed dose.

To compare and analyze the radiation dose and diagnostic performance of different mammography positions combinations of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) for different density types of breasts.

This retrospective study involved 1,195 patients who underwent simultaneous breast DBT and FFDM. The mammography combinations were Group A, FFDM(CC+MLO); Group B, FDM(CC)+DBT(MLO); Group C, FFDM(MLO)+DBT(CC); Group D, DBT(CC+MLO); and Group E, FFDM(CC+MLO)+DBT(CC+MLO). An intergroup comparative analysis of radiation dose and diagnostic performance of different combinations of mammography positions for different breast density types was performed using the pathologic and 24-month follow-up results as the diagnostic basis.

Overall, 2,403 mammograms indicated 477 cases of non-dense breast tissues and 1,926 cases of dense breast tissues. Differences in the mean radiation dose for each non-dense and dense breast group were statistically significant. The areas under the diagnostic receiver operating characteristic (ROC) curves for the non-dense breast group were not statistically significant. In the dense breast group, the z-values were 1.623 (p = 0.105) and 1.724 (p = 0.085) for the area under the ROC curve in Group C compared with Groups D and E, respectively, and 0.724 (p = 0.469) when comparing Group D with Group E. The differences between the remaining groups were statistically significant.

Group A had the lowest radiation dose and no significant difference in diagnostic performance compared with the other non-dense breast groups. Group C had high diagnostic performance in the dense breast group considering the low radiation dose.

Inadvertent puncture of the adjacent structures during a central venous catheterization is a well-known complication which may be managed conservatively when the injury is self-limiting, but requires a further treatment when there’s a proof of an active bleeding and/or a growing hematoma.

We report a case of a 57-year-old bone-marrow-transplant patient with neck hematoma and bleeding followed by a non-sonographic-guided central venous line placement. CT showed a right sided hematoma in the neck region with a midline shift of the airway. The patient was under prophylactic LMWH. Emergent angiography demonstrated three different bleeding sites which were successfully embolized with coil and liquid embolic agents by endovascular means.

Interventional radiology offers a quick and safe approach in the management of potentially life-threatening bleeding complications.

Toxoplasma gondii (T. gondii) infection is not uncommon in daily life, primary infection with T. gondii acquired during gestation may lead to a series of fetal complications. Prenatal ultrasound and postpartum neonatal T. gondii encephalitis have been reported previously, but fetal MRI findings of T. gondii encephalitis are quite rare. It is important to identify the severity of cerebral damage and assess fetal prognosis.

The purpose of this report is to emphasize that MRI can provide more excellent anatomic information on abnormalities in cerebral parenchyma than ultrasound, which is helpful for the diagnosis of prenatal infectious encephalitis.

A 38-year-old woman presented to our hospital at a gestation age of 29 weeks due to an ultrasound that showed fetal ventriculomegaly. The fetus demonstrated ventriculomegaly, intrauterine growth restriction, and multiple cystic lesions close to the corticomedullary junction of the frontal, temporal and parietal lobes on both sides. The woman chose to terminate the pregnancy, and pathological examination confirmed the diagnosis of congenital toxoplasma encephalitis.

This is a rare report of MRI manifestations of fetal congenital toxoplasma encephalitis. Detailed knowledge of MRI findings in fetal congenital toxoplasma encephalitis is helpful for prenatal consultation and pregnancy management.

The cerebellar tentorium, the second-largest dural reflection in the brain, separates supratentorial and infratentorial structures. This study aimed to determine the frequency of tentorial hypoplasia (TH) and gyral herniation and their relationship with clinical findings.

The standard brain MRIs were examined retrospectively. The presence of TH and laterality were investigated. If hypoplasia was accompanied by a gyrus extending inferior to the line where the tentorium should be located, this was recorded as tentorial hypoplasia-herniated gyrus (TH-HG), while the cases with hypoplasia alone were noted as isolated TH. It was also determined which gyrus or gyri were herniated. The clinical findings of the patients were obtained, and the correlation between HG was explored.

Standard brain MRIs of the 2051 patients were evaluated. Two hundred ten patients were excluded from the study due to different intracranial disorders, and 1841 patients, 739 (40.1%) males, and 1102 (59.9%) females, were included. Isolated TH or TH-HG was present in 56 patients, resulting in a prevalence of 3.04%. Of the patients with TH or TH-HG, 15 were men, and 41 were women. TH and TH-HG were significantly more common in women (p=0.038). TH-HG was unilateral in 22 (39.2%) patients and bilateral in 21 (37.5%). Left TH was found in 11 (19.6%) patients, left TH-HG in 29 (51.7%), right TH in eight (14.2%), and left TH-HG in 35 (62.5%).

Hypoplasia of the tentorium is a rare and unknown anomaly that can be easily diagnosed using MRI, and different gyral herniations may accompany TH.