Current Medical Imaging - Current Issue

This study aims to discuss the treatment of congenital recto-vestibular fistula and recto-perineal fistula, and the effect of the megarectum on defecation.

Congenital recto-vestibular fistula or recto-perineal fistula is the most common type of anorectal malformation, and surgical methods include posterior sagittal anorectoplasty, anterior sagittal anorectoplasty, and mid-sagittal anorectoplasty, which can be performed at stage one or stage two after the ostomy. In the later stages of a recto-vestibular fistula, constipation is a common complication. Rectal dilatation is frequently associated with constipation, and the effect of rectal dilatation on defecation should be discussed for patients with congenital recto-vestibular or recto-perineal fistula who had rectal dilatation prior to surgery. Rectal dilatation may be one of the causes of constipation for congenital recto-vestibular fistula and recto-perineal fistula.

The patients in this study were 67 children with congenital recto-vestibular fistula or recto-perineal fistula treated in our hospital from March 2013 to February 2017. All patients underwent an MRI of the spine and a barium enema. Six patients with myelodysplasia and sacral agenesis were excluded from this study. There were 18 patients with rectal dilatation (ages: 4-month-old to 1 year old, male: 3, female: 15). Seven of them had anterior sagittal anorectoplasty (group A), and 11 had anorectoplasty with dilated rectum resection (group B). Forty-three patients (ages: 3- to 10 months old, male: 6; female: 37) without a dilated rectum underwent anterior sagittal anorectoplasty (group C).

All patients were followed up for 1 year to 5 years. Among the 50 patients who had undergone an anoplasty, 5 out of 7 patients with rectal dilatation developed post-operative constipation, and 3 of them had normal defecation after the second resection of the dilated rectum. Only two out of 43 patients without rectal dilatation developed post-operative constipation. One out of 11 patients with rectal dilatation who underwent anoplasty and resection of the dilated rectum developed post-operative constipation.

Patients with congenital recto-vestibular fistula or recto-perineal fistula complicated by rectal dilatation are more susceptible to post-operative constipation. Resection of the dilated rectum at the same time can reduce the incidence rate of constipation. A barium enema should be performed pre-operatively for patients with congenital recto-vestibular fistula or recto-perineal fistula. If the dilated rectum is found, it can be resected at the same time.

Coronary cameral fistula is a rare cardiovascular anomaly, and usually needs advanced image modalities, such as computerized tomography and/or angiography, to confirm its existence. A few reports in the literature have addressed the role of medical ultrasound in the diagnosis of this disease, without a comprehensive summary of all the valuable echocardiographic features in its diagnosis.

Hereby, we presented an 80-year-old lady with exertional dyspnea and angina. We diagnosed coronary cameral fistula from the left anterior descending artery into the left ventricle by echocardiography with “intramyocardial vascular channel and the diastolic flow”, and “multiple diastolic flow jets into heart chamber from heart wall”. We confirmed the diagnosis with coronary angiography later. In the discussion, we make a comprehensive summary to conclude all the echocardiographic findings of this disease into 3 categories.

We believe the identification of those findings will prompt the early diagnosis of this rare anomaly.

Cardiac hemangiomas account for only 2.8% of primary cardiac tumors and are caused by the abnormal proliferation of endothelial cells and excess blood vessels. Typical radiological findings of cardiac hemangioma demonstrate intense contrast enhancement.

Here we report the case of a 69-year-old man who presented with a right atrial mass found incidentally with multimodal imaging findings, including echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI). This case presented with poor enhancement within right atrial mass on dynamic contrast-enhanced CT scan and gadolinium-enhanced first-pass perfusion image of cardiac MRI. After surgical resection, the pathologic diagnosis of cardiac capillary hemangioma was made.

Cardiac hemangioma could be included in the differential diagnosis for cardiac neoplasms demonstrating poor enhancements on CT and MRI scans.

To explore the feasibility of applying computed tomography perfusion (CTP) imaging-guided mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion beyond the therapeutic time window.

The clinical data of acute cerebral infarction patients with large vessel occlusion who were beyond the therapeutic time window and admitted to Handan Central Hospital from January 2021 to March 2022 were retrospectively analyzed. All patients were assessed by the National Institutes of Health Stroke Scale (NIHSS) and were examined by one-stop CTP imaging. The preoperative onset time of the disease was more than 6 h. Fourteen patients underwent magnetic resonance imaging examination at the same time. Fifty-four patients were retrospectively divided into two groups based on the treatment methods: the mechanical thrombectomy group had 21 patients and the conservative treatment group had 33 patients. NIHSS scoring and computed tomography scan were performed before treatment, 6 h, 24 h, 7 days, and 30 days after treatment.

The NIHSS scores of the patients with acute cerebral large vessel occlusion who underwent CTP imaging-guided mechanical thrombectomy at 6 h, 24 h, 7 days, and 30 days after treatment were compared with those of the conventional treatment group. The NIHSS score of the mechanical thrombectomy group was significantly better, and the difference was statistically significant (P < 0.05). In terms of the prognosis rate and expansion rate of infarct core volume, the patients of the mechanical thrombectomy group had a better prognosis, and the difference was statistically significant (P < 0.05). Artificial intelligence-assisted CTP diagnosis can facilitate the automatic evaluation of diseases and enable quick judgments that are independent of radiologists’ evaluation, but it may pose a problem in the determination of infarct core volume (either being too high or too low).

It is of great significance to apply CTP imaging in guiding the mechanical thrombectomy procedure in acute stroke patients with large vessel occlusion who are beyond the therapeutic time window.

There is currently no clinically accepted method for quantifying background parenchymal enhancement (BPE), though a sensitive method might allow individualized risk management based on the response to cancer-preventative hormonal therapy.

The objective of this pilot study is to demonstrate the utility of linear modeling of standardized dynamic contrast-enhanced MRI (DCEMRI) signal for quantifying changes in BPE rates.

On a retrospective database search, 14 women with DCEMRI examinations pre- and post-treatment with tamoxifen were identified. DCEMRI signal was averaged over the parenchymal ROIs to obtain time-dependent signal curves S(t). The gradient echo signal equation was used to standardize scale S(t) to values of FA = 10° and TR = 5.5 ms, and obtain the standardized DCE-MRI signal Sp(t). Relative signal enhancement was calculated from Sp, and the reference tissue method for T1 calculation was used to standardize to gadodiamide as the contrast agent, obtaining . in the first 6 minutes post-contrast administration was fit to a linear model with the slope α denoting the standardized rate relative BPE.

Changes in α were not found to be significantly correlated with the average duration of tamoxifen treatment, age at the initiation of preventative treatment, or pre-treatment BIRADS breast density category. The average change in α showed a large effect size of -1.12, significantly higher than -0.86 observed without signal standardization (p < 0.01).

Linear modeling of BPE in standardized DCEMRI can provide quantitative measurements of BPE rates, improving sensitivity to changes due to tamoxifen treatment.

The concept of occult breast carcinoma (OBC) was first described in 1907 by Halsted, who described this type of breast cancer to arise from small, undetectable tumours in the breast that had already metastasized to the lymph nodes. Although the breast is the most likely site for the primary tumour, non-palpable breast cancer presenting as an axillary metastasis has been reported, but with a low frequency of less than 0.5% of all breast cancers. OBC represents a complex diagnostic and therapeutic dilemma. Considering its rarity, clinicopathological information is still limited.

A 44-year-old patient presented to the emergency room with an extensive axillary mass as the first manifestation. Conventional evaluation of the breast with mammography and ultrasound was unremarkable. However, a breast MRI confirmed the presence of conglomerate axillary nodes. A supplementary whole-body PET-CT established the axillary conglomerate with a malignant behaviour with SUVmax of 19.3. The primary tumour was not detected in the breast tissue of the patient, confirming the diagnosis of OBC. Immunohistochemical results showed positive receptors for estrogen and progesterone.

Although OBC is a rare diagnosis, its existence is a possibility in a patient with breast cancer. Mammography and breast ultrasound with unremarkable findings but with high clinical suspicion should be supplemented with additional imaging methods, such as MRI and PET-CT, emphasizing the appropriate pre-treatment evaluation.

Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare, rapidly progressive, primary intestinal T-cell lymphoma. The most common site of occurrence is on the small intestine. The prognosis of MEITL is extremely poor due to delayed diagnosis and lack of targeted therapy.

A case of MEITL involving the entire small bowel, part of the colon, rectum, mesenteric lymph nodes, and liver is herein reported. We are presenting the ¹⁸F-FDG PET/CT features of MEITL, which showed all involved lesions with increased FDG activity. The MRI and pathological characteristics of MEITL were also described. Furthermore, some malignant diseases and benign diseases should be considered in the differential diagnosis.

Based on the lesions with a high accumulation of FDG, our case shows the involved extent of MEITL, which is helpful for biopsy and treatment option decisions. We expect more could know about this disease and make an early diagnosis to improve the outcomes of MEITL.

This study aimed to automatically implement liver disease quantification (DQ) in lymphoma using CT images without lesion segmentation.

Computed Tomography (CT) imaging manifestations of liver lymphoma include diffuse infiltration, blurred boundaries, vascular drift signs, and multiple lesions, making liver lymphoma segmentation extremely challenging.

The method includes two steps: liver recognition and liver disease quantification. We use the transfer learning technique to recognize the diseased livers automatically and delineate the livers manually using the CAVASS software. When the liver is recognized, liver disease quantification is performed using the disease map model. We test our method in 10 patients with liver lymphoma. A random grouping cross-validation strategy is used to evaluate the quantification accuracy of the manual and automatic methods, with reference to the ground truth.

We split the 10 subjects into two groups based on lesion size. The average accuracy for the total lesion burden (TLB) quantification is 91.76% ± 0.093 for the group with large lesions and 95.57% ± 0.032 for the group with small lesions using the manual organ (MO) method. An accuracy of 85.44% ± 0.146 for the group with larger lesions and 81.94% ± 0.206 for the small lesion group is obtained using the automatic organ (AO) method, with reference to the ground truth.

Our DQ-MO and DQ-AO methods show good performance for varied lymphoma morphologies, from homogeneous to heterogeneous, and from single to multiple lesions in one subject. Our method can also be extended to CT images of other organs in the abdomen for disease quantification, such as Kidney, Spleen and Gallbladder.

At present, early detection of the potential risk of atherosclerosis and prevention is of great significance to reduce the occurrence of stroke.

This study aims to explore the value of combining the wall shear stress measured by ultrasound vector flow imaging technique and sound touch elastography of common carotid artery in normal adults using the Mindray Resona 7 ultrasound system.

Forty volunteers (mean age 39.5 y, 23 females, 17 males) were divided into four groups according to their age. All volunteers underwent ultrasound carotid artery examination, and the values of wall shear stress and elasticity on the posterior wall of the common carotid artery were measured using advanced imaging functions, vector flow imaging technique, and sound touch elastography.

Different cut-off values of wall shear stress were used to investigate the significance between two groups with corresponding sound touch elastography values. It can be seen that the statistical difference could be found when the mean wall shear stress was larger than 1.5 Pa approximately (statistical significance was defined when P < 0.05), and the sound touch elastography value was positively correlated with the wall shear stress value.

This study reveals that the combination of wall shear stress and sound touch elastography is an effective and feasible method for assessing carotid artery health. When the mean wall shear stress value is over 1.5 Pa, the corresponding sound touch elastography value increases significantly. The risk of atherosclerosis increases with the stiffness of blood vessel walls.

Neuroimaging has helped us learn about the stages of brain development from infancy to maturity. Neuroimaging helps physicians diagnose mental illnesses and find novel treatments for them. It can distinguish depression from neurodegenerative diseases or brain tumors, and it can reveal structural defects that cause psychosis. Psychosis has been linked to lesions in the frontal or temporal lobes of the brain, as well as the thalamus and hypothalamus, which can be detected using a brain scan for mental illnesses. Neuroimaging uses quantitative and computational methods to explore the central nervous system. It can detect brain injuries and psychological illnesses. Thus, a systematic review and meta-analysis of randomized controlled trials using neuroimaging to detect psychiatric disorders assessed their efficacy and benefits.

Appropriate articles were searched from PubMed, MEDLINE, and CENTRAL databases using the appropriate keywords as per the PRISMA guidelines. Randomized controlled trials and open-label studies were included as per the predefined PICOS criteria. Meta-analysis was performed using the RevMan software, and statistical parameters like odds ratio and risk difference were calculated.

Twelve randomized controlled clinical trials with a total of 655 psychiatric patients were included following the criteria from the year 2000 to 2022. We included studies that use different neuroimaging techniques for the detection of organic brain lesions that would help diagnose psychiatric disorders. The primary outcome was detecting brain abnormalities in diverse psychiatric illnesses with neuroimaging versus conventional methods. We found the odds ratio value of 2.29 (95% CI 1.49-3.51). The results were heterogeneous with a Tau² value of 0.38, chi² value of 35.48, df value of 11, I² value of 69%, the z value of 3.78, and p-value less than 0.05. The risk difference is 0.20 (95% CI 0.09 -0.31) with heterogeneity of Tau2 value of 0.03, chi2 value of 50, df value of 11, I² value of 78%, the z value of 3.49, and p-value less than 0.05.

The present meta-analysis strongly recommends the use of neuroimaging techniques for the detection of psychiatric disorders.

Extra-adrenal non-functional adrenocortical carcinoma (ACC)is an extremely rare tumor with only eight cases having been reported at different localizations.

A 60-year-old woman was presented to our hospital with abdominal pain. Magnetic resonance imaging revealed a solitary mass abutting the wall of the small bowel. She underwent resection of the mass, and the results of histopathology and immunohistochemistry were consistent with ACC.

We report the first occurrence of non-functional adrenocortical carcinoma in the wall of the small bowel in the literature. Magnetic resonance examination is sensitive enough to indicate the accurate location of the tumor and is of great help to clinical operation.

Schwannomas arise from nerve sheaths of cranial, peripheral, and spinal nerve or nerve roots. Most intracranial schwannomas arise from the cranial nerves, predominantly the vestibulocochlear nerve. In addition to cranial nerve schwannomas, intraparenchymal schwannomas of the brain and intramedullary schwannomas of the spinal cord are extremely rare.

In our case we describe the imaging findings of three diverse cases of schwannoma at different locations and unique presentations with acute neurological symptoms in the pediatric age group.

Schwannomas should be included in the differential diagnosis of intracranial or intraspinal intramedullary space-occupying lesions in pediatric patients.

The COVID-19 pandemic has resulted in a large number of deaths and has caused a significant increase in population morbidity. This viral infection has been associated with different neurological symptoms and complications that do not have a clear pathophysiological mechanism and exact implications for these patients.

A 40-year-old man with COVID-19 and co-infection with Klebsiella pneumoniae KPC presented extensive pulmonary involvement and required comprehensive management in the intensive care unit (ICU). During his hospitalization, he developed neurological symptoms with evidence of involvement of the corpus callosum, which was attributed to the cytotoxic lesion of the corpus callosum (CLOCC). After several months of interdisciplinary management in the ICU, there was a progressive improvement in his general condition, with discharge from the hospital without significant sequelae, with follow-up images showing complete involvement of the corpus callosum due to what was considered an atypical cytotoxic lesion of the corpus callosum.

Imaging features of CLOCCs are known to be temporary, but in the setting of COVID-19, it has not yet been determined if this is true and further studies are needed. Nonetheless, the one-year follow-up of our patient makes us believe that this atypical involvement of the corpus callosum described in severe SARS-CoV-2 infections is not transitory, even if there are no neurologic sequelae.

COVID-19 has become a worldwide epidemic disease and a new challenge for all mankind. The potential advantages of chest X-ray images on COVID-19 were discovered. We proposed a lightweight and effective Convolution Neural Network framework based on chest X-ray images for the diagnosis of COVID-19, named AMResNet.

COVID-19 has become a worldwide epidemic disease and a new challenge for all mankind. The potential advantages of chest X-ray images on COVID-19 were discovered.

A lightweight and effective Convolution Neural Network framework based on chest X-ray images for the diagnosis of COVID-19.

By introducing the channel attention mechanism and image spatial information attention mechanism, a better level can be achieved without increasing the number of model parameters.

In the collected data sets, we achieved an average accuracy rate of more than 92%, and the sensitivity and specificity of specific disease categories were also above 90%.

The convolution neural network framework can be used as a novel method for artificial intelligence to diagnose COVID-19 or other diseases based on medical images.

Whether deep learning-based CT reconstruction could improve lesion conspicuity on abdominal CT when the radiation dose is reduced is controversial.

To determine whether DLIR can provide better image quality and reduce radiation dose in contrast-enhanced abdominal CT compared with the second generation of adaptive statistical iterative reconstruction (ASiR-V).

This study aims to determine whether deep-learning image reconstruction (DLIR) can improve image quality.

In this retrospective study, a total of 102 patients were included, who underwent abdominal CT using a DLIR-equipped 256-row scanner and routine CT of the same protocol on the same vendor's 64-row scanner within four months. The CT data from the 256-row scanner were reconstructed into ASiR-V with three blending levels (AV30, AV60, and AV100), and DLIR images with three strength levels (DLIR-L, DLIR-M, and DLIR-H). The routine CT data were reconstructed into AV30, AV60, and AV100. The contrast-to-noise ratio (CNR) of the liver, overall image quality, subjective noise, lesion conspicuity, and plasticity in the portal venous phase (PVP) of ASiR-V from both scanners and DLIR were compared.

The mean effective radiation dose of PVP of the 256-row scanner was significantly lower than that of the routine CT (6.3±2.0 mSv vs. 2.4±0.6 mSv; p< 0.001). The mean CNR, image quality, subjective noise, and lesion conspicuity of ASiR-V images of the 256-row scanner were significantly lower than those of ASiR-V images at the same blending factor of routine CT, but significantly improved with DLIR algorithms. DLIR-H showed higher CNR, better image quality, and subjective noise than AV30 from routine CT, whereas plasticity was significantly better for AV30.

DLIR can be used for improving image quality and reducing radiation dose in abdominal CT, compared with ASIR-V.

The dimensions of the liver, spleen, and kidneys either change in primary diseases related to these organs or in secondary diseases that indirectly affect them, such as diseases of the cardiovascular system. Therefore, we aimed to investigate the normal dimensions of the liver, kidneys, and spleen and their correlations with body mass index in healthy Turkish adults.

A total of 1,918 adults older than 18 years of age underwent ultrasonographic (USG) examinations. Participants’ age, sex, height, weight, BMI, liver, spleen, and kidney dimensions, biochemistry and haemogram results were recorded. The relationships between organ measurements and these parameters were examined.

A total of 1,918 patients participated in the study. Of these, 987 (51.5%) were female and 931 (48.5%) were male. The mean age of the patients was 40.74± 15.95 years. The liver length (LL) for men was found to be greater than that for women. The effect of the sex factor on the LL value was statistically significant (p = 0.000). The difference between men and women in terms of liver depth (LD) was statistically significant (p=0.004). The difference between BMI groups in terms of splenic length (SL) was not statistically significant (p=0.583). The difference between BMI groups in terms of splenic thickness (ST) was statistically significant (p=0.016).

We obtained the mean normal standard values of the liver, spleen, and kidneys in a healthy Turkish adult population. Consequently, values exceeding those in our findings will guide clinicians in the diagnosis of organomegaly and will contribute to filling the gap in this regard.

The artifacts produced by calcification on coronary computed tomographic angiography (CCTA) have a great influence on the diagnosis of coronary stenosis. The purpose of this study is to investigate the value of corrected coronary opacification (CCO) difference in the diagnosis of stenosis in diffusely calcified coronary arteries (DCCAs).

A total of 84 patients were enrolled. The CCO difference across the diffuse calcification was measured through CCTA. Coronary arteries were grouped according to the extent of stenosis obtained by invasive coronary angiography (ICA). The Kruskal-Wallis H test was used to compare the CCO differences between different groups and a receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of the CCO difference.

Among the 84 patients, 58 patients had one DCCA, 14 patients had 2 DCCAs, and 12 patients had 3 DCCAs. A total of 122 coronary arteries were examined, 16 showed no significant stenosis, 42 had <70% stenosis, and 64 had 70-99% stenosis. The median CCO differences among the 3 groups were 0.064, 0.117, and 0.176, respectively. There were significant differences between the group without stenosis and the group with 70-99% stenosis (H = -3.581, P = 0.001), and between the group with <70% stenosis and the group with 70-99% stenosis (H = -2.430, P = 0.045). The area under the ROC curve was 0.681 and the optimal cut-off point was 0.292. Taking the ICA results as the gold standard, the sensitivity and specificity for the diagnosis of ≥70% coronary stenosis with a cut-off point of 0.292 were 84.4% and 44.8%, respectively.

CCO difference could be useful in the diagnosis of ≥70% severe coronary stenosis in DCCA. Through this non-invasive examination, the CCO difference could be a reference for clinical treatment.

Although the essential components of pain pathways have been identified, a thorough comprehension of the interactions necessary for creating focused treatments is still lacking. Such include more standardised methods for measuring pain in clinical and preclinical studies and more representative study populations.

This review describes the essential neuroanatomy and neurophysiology of pain nociception and its relation with currently available neuroimaging methods focused on health professionals responsible for treating pain.

Conduct a PubMed search of pain pathways using pain-related search terms, selecting the most relevant and updated information.

Current reviews of pain highlight the importance of their study in different areas from the cellular level, pain types, neuronal plasticity, ascending, descending, and integration pathways to their clinical evaluation and neuroimaging. Advanced neuroimaging techniques such as fMRI, PET, and MEG are used to better understand the neural mechanisms underlying pain processing and identify potential targets for pain therapy.

The study of pain pathways and neuroimaging methods allows physicians to evaluate and facilitate decision-making related to the pathologies that cause chronic pain. Some identifiable issues include a better understanding of the relationship between pain and mental health, developing more effective interventions for chronic pain's psychological and emotional aspects, and better integrating data from different neuroimaging modalities for the clinical efficacy of new pain therapies.