Current Medical Imaging - Volume 15, Issue 4, 2019

Background: Three-Dimensional visualization of brain tumors is very useful in both diagnosis and treatment stages of brain cancer. Discussion: It helps the oncologist/neurosurgeon to take the best decision in Radiotherapy and/or surgical resection techniques. 3D visualization involves two main steps; tumor segmentation and 3D modeling. Conclusion: In this article, we illustrate the most widely used segmentation and 3D modeling techniques for brain tumors visualization. We also survey the public databases available for evaluation of the mentioned techniques.

Background: Primary Hepatic Epithelioid Haemangioendothelioma (HEHE) and Primary Hepatic Angiosarcoma (PHA) are rare mesenchymal tumours with different malignant potential. Whereas HEHE demonstrates low to intermediate malignant potential, PHA is an aggressive malignancy with poor prognosis. The knowledge of typical imaging features of these lesions may facilitate correct diagnosis; however, the ultimate diagnosis of HEHE and PHA is based on histopathologic examination. Discussion: The most typical findings helpful in diagnosing HEHE are: Presence of multiple, confluent nodules located at the liver periphery (in young to middle-aged woman), retraction of the liver capsule, marked hyperintensity on T2-weighted images, “target-sign” appearance, progressive centripetal contrast enhancement, and relatively high Apparent Diffusion Coefficient (ADC) values. More than ≥50% of nodules are hyper- or isointense on Hepatobiliary Phase (HBP) images. Conclusion: The imaging features suggestive of PHA are: Occurrence of metastases (lungs, spleen) at the time of diagnosis, presence of a large dominant mass with smaller satellites, heterogeneity and areas of haemorrhage in a dominant mass, progressive contrast enhancement, slightly elevated ADC values as compared to other malignant liver tumours.

Objective: Ascending Reticular Activating System (ARAS) has a key role in consciousness. The ARAS is a complex network consisting of a portion of the brainstem reticular formation, nonspecific thalamic nuclei, hypothalamus, Basal Forebrain (BF), and cerebral cortex. We examined the reconstruction method and features of the neural tract between the hypothalamus and the BF in normal subjects, using Diffusion Tensor Tractography (DTT). Methods: Twenty-three healthy subjects were recruited. The ARAS between the hypothalamus and the BF was reconstructed by two Regions of Interest (ROIs): 1) seed ROI - the isolated green portion for the BF on the color map, 2) target ROI - the hypothalamus on the axial image. DTT parameters of the ARAS between the hypothalamus and the BF were examined. Results: Among 46 hemispheres in 23 normal subjects, 24 hemispheres (52.2 %) were identified in the ARAS between the hypothalamus and the BF. The reconstructed ARAS between the hypothalamus and the BF connected from the hypothalamus to the commissural level and anteriorly through the anterior commissure and then reached the BF. Conclusion: Using DTT, the ARAS between the hypothalamus and the BF was identified in normal subjects. Because the hypothalamus and BF are related to the regulation of wakefulness and sleep, our reconstruction method and results would be useful in the research on sleep and wakefulness aspects of consciousness.

Purpose: To investigate image quality, and radiation dose between ECG-gated singlesource and dual-source CT Angiography (CTA) protocols for planning of Trans-catheter Aortic Valve Implantation (TAVI) with a reference non ECG-gated single-source protocol. Methods: A total of 120 patients were included in four groups: Non ECG-gated single-source (SS), ECG-gated single-source (SSECG), ECG-gated dual-source high-pitch (DSECG), or non-ECG-gated dual-source high-pitch mode (DS). Qualitative image quality of the aortic annulus, aortic valve, and coronary ostia as well as presence of motion or stair-step artefacts of the thoracic aorta were independently assessed by two readers. Quantitative image quality was assessed to calculate contrast to noise ratio. Results: Subjective and objective scoring of motion artefacts was significantly reduced in SSECG, DSECG and DS (p= 0.010). The imaging length was comparable between groups. Aortic annulus, aortic valve, and coronary ostia were reliably evaluable in all patients with SSECG, DSECG and DS protocols. Conclusion: High-pitch, dual-source CT angiography of the whole aorta with or without ECG gating is a dose-efficient and time-saving examination strategy before TAVI. However acquisition timing within the cardiac cycle needs to be taken into account.

Background: Transarterial Chemoembolization (TACE) is a minimally invasive treatment in managing unresectable liver primary neoplasms or liver metastases. Postembolization Syndrome (PES) is the most common adverse effect after TACE procedures. Objective: We investigate the risk factors for the development of PES after TACE therapy in patients with primary or metastatic liver tumors. Methods: In a retrospective analysis of 163 patients who underwent TACE between 01/01/2012 and 31/01/2018, patients that were given medication due to pain, fever, nausea or vomiting were evaluated and noted with PES. Analyses were made to evaluate factors such as age, gender, chemotherapy agent and dose, tumor size, tumor type, a particle used for embolization, multiple tumor treatments and selective application of the procedure, which may lead to PES after TACE. Results: In a total of 316 patients, PES was observed at a rate of 55 percent after TACE. Tumor size, number of tumors treated and adopting super selective fashion in the procedure were found to be related to the development of PES. No relationship was found between age, gender, presence of ascites, tumor type, size of embolic agent and drug type and the development of PES. Conclusion: A treated tumor measuring >5 cm, treating more than one tumor, and the failure to perform the procedure in a super selective fashion increase the risk of PES development after TACE.

Background: In the presence of Cloud Environment and the migration of Electronic Health Systems and records to the Cloud, patient privacy has become an emergent problem for healthcare institutions. Government bylaws, electronic health documentation, and innovative internet health services generate numerous security issues for healthcare conformity and information security groups. To deal with these issues, healthcare institutes must protect essential IT infrastructure from unauthorized use by insiders and hackers. The Cloud Computing archetype allows for EHealth methods that improve the features and functionality of systems on the cloud. On the other hand, sending patients’ medical information and records to the Cloud entails a number of risks in the protection and privacy of the health records during the communication process. Aim: In this paper, a solution is proposed for the security of Electronic Health Records (EHRs) in cloud environment during the process of sending the data to the cloud. In addition, the proposed method uses biometric images that allow for unified patient identification across cloud-based EHRs and across medical institutions. Method: To protect the privacy of patients’ information and streamline the migration process, a watermarking-based method is proposed for health care providers to ensure that patients’ data are only accessible to authorized personnel. Patients’ information, such as name, id, symptoms, diseases, and previous history, is secured in biometric images of patients as an encrypted watermark. Results: Quality and impeccability analysis and robustness were performed to test the proposed method. The PSNR values show that the proposed method produced excellent results. Conclusion: The robustness and impressibility of the proposed method were tested by subjecting the watermarked images to different simulated attacks. The watermarks were largely impermeable to varied and repeated attacks.

Objective: Standard treatment of differentiated thyroid cancer includes total thyroidectomy and high-dose Radioactive Iodine Therapy (RIT) for ablation of remnant thyroid tissue. When administered systemically, RIT can cause radiation-induced damage in non-targeted normal tissues. The aim of the present study was to compare the protective effects of amifostine (AMI), LCarnitine (LC), and Vitamin E (EVIT) against high dose radioactive iodine treatment induced Salivary Gland (SG) damage using SG scintigraphy and histopathological examination. Methods: Forty adult guinea pigs were studied. Twenty guinea pigs receive 555-660 MBq 131Iodine intraperitoneally (IP) to ablate the thyroid and impair the parenchymal function of the SGs. The animals were divided into eight groups as follows: (1) Group 1 (control): 1 mL IP PS (physiological saline); (2) Group 2: single dose of 200 mg/kg IP AMI one hour prior to 1 mL IP PS; (3) Group 3: 200 mg/kg IP LC and 1 mL IP PS for 10 days; (4) Group 4: 40 mg/kg intramuscular (IM) EVITand 1 mL IP PS for 10 days; (5) Group 5: IP RIT after premedication; (6) Group 6: Single dose of 200 mg/kg IP AMI one hour prior to RIT and IP RIT after premedication; (7) Group 7: IP RIT after premedication and 200 mg/kg IP LC for 10 days starting one day before RIT; and (8) Group 8: IP RIT after premedication and 40 mg/kg IM EVIT for 10 days starting one day before RIT. Scintigraphy was performed 1 month after treatment. SGs were examined by light microscopy and a histopathological scoring system was used to assess the degree of SG damage. Results: There were significant differences in the body weight and thyroid hormone levels between the groups after treatment. Conclusion: The individual use of AMI, LC and EVIT for radioprotection yield different levels of protection against radioactive iodine treatment injury in SGs; however, none of the agents could provide absolute protection at the doses administered in this experimental model.

Background: Lung Cancer is the disease spreading around the world nowadays. Early recognition of lung disease is a difficult task as the cells which cause tumor will grow quickly and the majority of these cells are enclosed with each other. From the beginning of the treatment, tumor detection handling systems which are generally utilized for the diagnosis of lung cancer, recognizable proof of hereditary and ecological elements is imperative in creating a novel technique for lung tumor detection. In different cancers, for example, lung cancer, the time calculated is imperative to find the anomaly issue in target images. Methods: In this proposed framework, GLCM (Gray Level Co-event Matrix) is utilized for preprocessing of images and to feature extraction procedures to check the condition of the patient whether it is ordinary or irregular. Surface-based elements, for example, GLCM (Gray Level Co-event Matrix) features assume a vital part of remedial image examination which is utilized for the identification of Lung cancer. In the event that lung cancer is effectively distinguished and anticipated in its initial stages, it lessens numerous treatment choices and furthermore, decreases the danger of intrusive surgery and increment survival rate. Results & Conclusion: The proposed method will efficiently identify the position of the tumor in lungs using the probability framework. This will offer a promising outcome for recognition and diagnosis of lung cancer. In this manuscript, GLCM features are used for the prediction of lung tumor and tests are performed for performance analysis in comparison with the histogram and GLCM features, in which GLCM features are accurate in predicting lung tumor even if it takes more time than histogram features. In this manner, early discovery and probability of lung cancer should assume a crucial task in finding a procedure and furthermore, an increment in the survival rate of the patient. This exploration investigates machine learning systems which consider quality articulation, to perceive cancer or to identify lung cancer.

Background: Carotid artery images indicate any presence of plaque content, which may lead to atherosclerosis and stroke. Early identification of the disease is possible by taking B-mode ultrasound images in the carotid artery. Speckle is the inherent noise content in the ultrasound images, which essentially needs to be minimized. Objective: The objective of the proposed method is to convert the multiplicative speckle noise into additive, after which the frequency transformations can be applied. Method: The method uses simple differentiation and integral calculus and is named variable gradient summation. It differs from the conventional homomorphic filter, by preserving the edge features to a great extent and better denoising. The additive image is subjected to wavelet decomposition and further speckle filtering with three different filters Non Local Means (NLM), Vectorial Total Variation (VTV) and Block Matching and 3D filtering (BM3D) algorithms. By this approach, the components dependent on the image are identified and the unwanted noise content existing in the high frequency portion of the image is removed. Results & Conclusion: Experiments conducted on a set of 300 B-mode ultrasound carotid artery images and the simulation results prove that the proposed method of denoising gives enhanced results as compared to the conventional process in terms of the performance evaluation methods like peak signal to noise ratio, mean square error, mean absolute error, root mean square error, structural similarity, quality factor, correlation and image enhancement factor.

Background: Hypoplastic coronary artery disease is a rare congenital coronary artery anomaly. It is often detected incidentally, and its true incidence in the general population is not known. Discussion: Symptoms of HCAD are syncope, palpitations, dyspnea, and chest pain. Also, arrhythmia and myocardial infarction can be seen; these can cause sudden death, especially in athletes and young people. Diagnosis is often made at autopsy. Conclusion: Here, we present the case of a 39-year-old male with isolated hypoplasia of the left circumflex artery detected by coronary Computed Tomography (CT) angiography who complained of palpitation.