Current Medical Imaging - Volume 19, Issue 11, 2023

Background: Lung cancer has the highest mortality rate among cancers. Radiation therapy (RT) is one of the most effective therapies for lung cancer. The correct segmentation of lung tumors (LTs) and organs at risk (OARs) is the cornerstone of successful RT. Methods: We searched four databases for relevant material published in the last 10 years: Web of Science, PubMed, Science Direct, and Google Scholar. The advancement of deep learning-based segmentation technology for lung cancer radiotherapy (DSLC) research was examined from the perspectives of LTs and OARs. Results: In this paper, Most of the dice similarity coefficient (DSC) values of LT segmentation in the surveyed literature were above 0.7, whereas the DSC indicators of OAR segmentation were all over 0.8. Conclusion: The contribution of this review is to summarize DSLC research methods and the issues that DSLC faces are discussed, as well as possible viable solutions. The purpose of this review is to encourage collaboration among experts in lung cancer radiotherapy and DL and to promote more research into the use of DL in lung cancer radiotherapy.

Background: It is still uncertain to determine the exact diagnostic accuracy of MRI for medial meniscus (MM) tear, lateral meniscus (LM) tear and MM posterior root tear (MMPRT) at different magnetic field intensities (MFIs), different sequences and different publication dates. This study aimed to identify the diagnostic performance of MRI for different meniscus lesions at different MFIs, different sequences and different publication dates, and also to compare it with physical examination. Methods: PubMed, Embase, Ovid database, Biosis Previews, Cochrane library, Web of Sciences and manual searching were performed from 1 January 2000 to 31 December 2021. Prospective studies of meniscus injuries examined by physical examination, MRI and arthroscopy were included. Results: Thirteen studies with 1583 meniscal tears were included. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR) and area under curve (AUC) were 87% (95% confidence interval (CI), 86-89%), 82% (80-83%), 7.44 (5.11- 10.75), 0.18 (0.14-0.23), 45.95 (26,68-79.15) and 0.93, respectively. The pooled specificity between MM and LM (p = 0.015), the pooled sensitivity and LR- between MM and MMPR (p = 0.031), different MRI sequences (p = 0.035, p = 0.027), and the accuracy of less than 1.5T and 3.0T (p = 0.04), 1.5T and 3.0T (p = 0.035) were statistically different. There was no publication bias (p = 0.54). Conclusion: MRI performed well in the diagnosis of MM tear, LM tear and MMPRT, and the diagnostic performance of physical examination is similar to MRI. The diagnostic accuracy of 3.0T is the highest, and the -weighted imaging (SWI) sequence may be beneficial for diagnosing meniscus tear. However, there are not enough evidence to prove that recent studies are significantly better than previous ones.

Background: Few studies comprehensively compared the performance of transient elastography (TE) and two-dimensional shear wave elastography(2D-SWE) to diagnose the stage of liver fibrosis in children and adolescents. We assessed the diagnostic performance of these non-invasive imaging techniques from published studies. Methods: To evaluate the diagnostic performance of TE and 2D-SWE, we searched the PubMed, Embase, Web of Science, and Cochrane Library databases until November 13, 2021, for studies that diagnosed liver fibrosis in children and adolescents. Pooled sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratios, and area under the receiver operating characteristic curve were estimated using the bivariate model. We also performed a subgroup analysis of various research characteristics. Results: Twenty-seven studies with 1956 patients were included in the analysis. The sensitivity and specificity of TE and 2D-SWE for detecting liver fibrosis in all stages were greater than 0.82. For the detection of significant fibrosis, advanced fibrosis and cirrhosis, the summary AUC was 0.90 (95% CI: 0.87-0.92), 0.95 (95% CI: 0.93-0.96) and 0.95 (95% CI: 0.93-0.97) for TE, and the summary AUC was 0.92 (95% CI: 0.89-0.94), 0.94 (95% CI: 0.92-0.96) and 0.96 (95% CI: 0.94-0.97) for 2D-SWE, respectively. Both imaging methods detected significant heterogeneity. mp;gt; Conclusion: TE and 2D-SWE can provide accurate non-invasive staging of liver fibrosis in children or adolescents and are a promising technology, particularly for advanced liver fibrosis and cirrhosis, with a high potential to replace liver biopsy.

Objective: To explore the MRI T2 fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVH) combined with diffusion-weighted imaging (DWI) Alberta Stroke Program Early CT Score (ASPECTS) in predicting the prognosis of acute cerebral infarction (ACI) with endovascular treatment. Methods: The patients with ACI in the anterior circulation who underwent endovascular treatment from June 2016 to December 2020 were divided into a good prognosis group and a poor prognosis group according to the modified Rankin Scale (mRS) score at 90 days after the operation. The differences in general clinical baseline data, CT-ASPECTS, FVH, and DWI-ASPECTS between the two groups were analyzed. The receiver operating characteristic (ROC) curve was used to analyze the predictive power of prediction models on prognosis. Results: The results of the Binomial Logistic regression equation showed initial National Institute of Health stroke scale (NIHSS), Mori grade, DWI-ASPECTS, and FVH were independent risk factors for prognosis. The predictive power of the FVH + DWI-ASPECTS prediction model was highest, and the predictive power of DWI-ASPECTS was higher than that of CT-ASPECTS. Conclusion: DWI-ASPECTS is better than CT-ASPECTS in predicting the prognosis of ACI with endovascular treatment, and the combined prediction model of FVH and DWI-ASPECTS has higher prediction performance, which can be used as a preoperative evaluation method to predict the effect of endovascular treatment for ACI.

Objective: The aim of this study is to determine the clinical and laboratory parameters which may be suggestive of or even pathognomonic for primary epiploic appendagitis (PEA) and to discuss the diagnostic efficacy of ultrasound (US) compared to computed tomography (CT) in patients with PEA. Materials and Methods: For this retrospective study, 92 patients diagnosed with PEA using US, CT or both modalities were included. All patient symptoms, clinical findings and laboratory parameters were reviewed. The CT and US images of the PEA were evaluated for lesion size and location, the relationship of the lesion to the colon and the distance of the lesion to the skin. Results: There were 16 female and 76 male patients in the study group. The mean age was 35 years (range: 38–79 years). Well-localized abdominal pain was the primary symptom in all patients. The mean leukocyte count was 7857±1326 mm^-3. The most frequent localization of PEA was sigmoiddescending colon junction (79/92). In patients who were examined by both US and CT, the size of the fatty central core was between 15-48 mm (mean:28.10 mm) and 9-22 mm (mean:15.07 mm) in its long-axis and short-axis diameter, respectively on US, whilst that by CT was between 15-46 mm (mean:26.88 mm) and 9-21 mm (mean:14.40 mm) in its long-axis and short-axis diameter, respectively. In patients who were examined by both US and CT, the mean distance of the lesions to the skin was 20.80 mm and 33.97 mm, respectively. All patients were treated conservatively with complete resolution of symptoms within a week of presentation. Conclusion: PEA is an unrare self-limiting condition that should be considered in the differential diagnosis of acute abdomen. To support clinicians and radiologists regarding PEA and its clinical, laboratory and radiological findings, targeted sonographic examination - which is radiation and contrast agent-free - could be highly sufficient for the diagnosis of PEA and may prevent unnecessary further imaging and mistreatment.

Purpose: To evaluate the diagnostic performance of three-dimensional volume of interest (3D-VOI) perfusion quantitative parameters using CS-VIBE DCE-MRI and investigate the relationship of the prognostic factors. Materials and Methods: The volumetric perfusion quantitative parameters of K^trans, Kep, Ve, Vp, of 124 pathologically proven breast masses in 93 patients were obtained using the two-compartment extended Tofts model. Also, the perfusion parameters of AUC, TTP, Emax, wash-in, and washout were automatically calculated using post-processing software. The relationship between the perfusion quantitative parameters and lesion size, pathology, and prognostic factors of malignancy was evaluated. Results: K^trans and Kep were significantly higher in the malignant than the benign lesions (p < 0.001), and the AUROC of K^trans and Kep was 0.802 and 0.815, respectively. The area under the DCE curve, TTP, Emax, wash-in, and wash-out were significantly different between the benign and malignant lesions (p < 0.05). In multiple linear regression analysis, K^trans and Kep were significantly different between benign and malignant tumors. Malignant tumors larger than 2cm were significantly different from those smaller than 2cm in K^trans, Kep, Vp, area under the DCE curve, TTP, Emax, and wash-in values (p < 0.05). TTP was significantly lower in higher Ki-67 index (p < 0.05). Conclusion: Perfusion quantitative parameters may be applied as a feasible imaging biomarker to discriminate malignant from benign tumors. In malignant lesions, perfusion parameters were not associated with histopathological results but only in tumor size.

Objectives: The position of the inferior alveolar canal (IAC) and its course in the mandible is crucial to prevent complications in oral surgical procedures. Therefore, the present study aims to predict the course of IAC using landmarks specific to the mandible and to correlate with cone-beam computed tomography images. Methods: On the included panoramic radiographs (n=529), the closest point of the IAC to the inferior border of the mandible (Q) was determined, and the distances of this point to the mental (Mef) and mandibular foramen (Maf) were measured in millimeters. To determine the buccolingual course of the IAC on CBCT images (n=529), the distances from the center of the canal to the buccal and lingual cortices and between the cortices were measured at the level of the root apices of the first and second premolars and molars. Also, the positions of the Mef to adjacent premolars and molars were classified. Results: The most common position of mental foramen was Type-3 (37.1%). On the coronal plane, it was also observed that as the Q point approaches the Mef, the IAC is located in the mandible's center at the second premolar level (p=0.008) and moves away from the midline at the level of the first molar (p=0.007). Conclusion: Based on the results, a correlation was observed between the horizontal course of the IAC and its proximity to the inferior border of the mandible. Therefore, the curvature of the IAC and its proximity to the mental foramen should be considered in oral surgeries.

Objective: To compare the efficacy and safety of 1.5 T MRI and CT-guided VX2 hepatic para-vascular tumor model in rabbits. Materials and Methods: Sixty New Zealand white rabbits were randomly and equally divided into MRI-guided group (n=30) and CT-guided group (n=30). Rabbit VX2 tumor fragments were implanted beside the rabbit hepatic great vessels under MRI and CT guidance in the MRI and CT group to evaluate the success rate of tumor model establishment, puncture needle display and tip peripheral vascular situation, operation time and safety. Results: In the MRI-guided group, 29 rabbits (29/30, 96.7%) had a successful establishment of liver tumor model, and 1 rabbit had needle metastasis. In the CT-guided group, 24 rabbits (24/30, 80%) had a successful establishment of liver tumor model, while 2 rabbits had needle metastasis, 3 rabbits had metastases in other parts of the liver, and 1 had an unknown cause of death. The differences in tumor model establishment success rate between the two groups were statistically significant (χ² = 4.043, P < 0.05). The fold number of artifacts at T1WI was 7.26±0.38 for the 20 G coaxial puncture needle in the MRI-guided group and 2.51±0.57 for the 20 G coaxial puncture needle in the CT-guided group, and the difference was statistically significant (t=36.76, P < 0.001), but star-shaped hypodense artifacts would appear around the needle tip. The operation time was longer in the MRI-guided group than in the CT-guided group (13.32±2.45 minutes in the MRI-guided group vs. 8.42±1.46 minutes in the CTguided group; t=9.252, P < 0.001). A small number of ascites occurred in 2 patients (2/30, 6.67%) in the CT-guided group; no serious complications such as liver abscess, jaundice or diaphragmatic perforation were observed in both groups. Conclusion: Compared with CT, MRI-guided hepatic para-vascular tumor implantation in rabbits might be a more effective modeling method. Although the needle tip pseudopacity of the puncture needle is large and the operation time is long, the incidence of complications is low.

Objective: The study aimed to analyze computed tomography and magnetic resonance imaging features of patients with solitary extramedullary plasmacytoma. Methods: Ten cases with solitary extramedullary plasmacytoma were included in this study. CT and MRI features of solitary extramedullary plasmacytoma were retrospectively analyzed. Results: This study included both males (n = 8) and females (n = 2), with a median age of 48 (range 21-72 years old). The organs or anatomical structures involved were nasopharynx (n = 3), orbit (n = 1), left tentorium (n = 1), nasal cavity and meatus (n = 2), small intestine and mesentery (n = 1), as well as posterior thoracic wall (n = 2). The median maximum diameter of the tumors was 3.2 cm (range 0.8- 15.2 cm). The tumor shapes were round (n = 7), stripped (n = 1), irregular (n = 1), and nodular (n = 1). The margin of the tumors was well-defined (n = 7) and partially well-defined (n = 3). There were 3 cases with bone destruction and 1 with a tissue invasion adjacent to the tumor, calcification (n = 1), and cystic degeneration (n = 2). Enlarged tumoral vessels (n = 4) could also be observed. The CT attenuation and MR signal intensity of tumors were heterogeneous (n = 4) and homogenous (n = 6). After the injection of the contrast agent, marked (n = 5), mild (n = 1), mild to moderate (n = 1), and delayed enhancement (n = 1) could be observed. Conclusion: A well-defined homogeneous solitary mass occurring at the head and neck with a marked enhancement, an adjacent tissue invasion, enlarged tumoral vessels, and bone destruction can indicate the diagnosis of solitary extramedullary plasmacytoma.

Background: Teratoma is a true neoplasm composed of a number of different types of tissue derived from the three germinal layers but rarely occurs in the middle ear (ME). The features of middle ear teratomas (MET) have not been well described. Objective: The objective of this study is to explore the clinical and imaging features of MET, and report 2 rare cases of MET with ear malformation that have never been reported. Materials and Methods: The clinical, CT and MRI data of 8 patients with a pathological diagnosis of MET were collected and retrospectively mined, and 14 patients with MET reported in previous literature were also reviewed. Results: 1. Female, left ear predominance in MET, and the most common symptoms were otorrhea and hearing loss. 2. On CT and MRI, the MET presented as an irregular soft tissue mass that was heterogeneous, with fatty tissue and involved multiple sites, and the ET and tympanum were correspondingly expanded and locally destroyed. 3. Mictotia with MET in two patients was presented, which was the first report. Conclusion: MET has female sex and left ear predominance. CT and MRI can be used to diagnose MET and display its extent and its relationship to the carotid canal in detail. Complete surgical excision is the definitive treatment.

Objective: Shear wave elastography imaging (SWE) is a non-invasive US technique that has been developed to provide quantitative information about tissue elasticity. This technique might be useful in the identification of vascular risk factors. Arterial wall thickness and inner diameter vary with age and disease, which may impact shear wave propagation. The effect of arterial geometry on SWE has not yet been thoroughly investigated. Therefore, this study aimed to investigate the impact of different wall thickness, pulsation and imaging planes on YM estimates, to gain more information about the source of variability associated with SWE. Methods: Poly(vinyl alcohol) cryogel (PVA-c) fabrication has been used for phantom design and construction. The agar-based TMM was used to surround the tubes. The inlet and outlet of the phantom were connected to a programmable gear pump using c-flex tubing to form a closed loop. Image J profiling was used to clarify the anomalies further detected using SWE. Results: The 4 F/T cycle vessel phantom has shown less YM variability than in the 6 F/T cycle. YM ranged from 8 kPa for a 1 mm thickness tube to 53 kPa for the thickest 6 mm wall thickness for the softer 4 F/T cycle tube. Vessel phantoms embedded in TMM show higher variability than vessel phantoms submerged in water. YM ranged from 32 kPa for a 1 mm thickness tube to 117 kPa for the thickest 6 mm wall thickness for the softer 4 F/T cycle tube. Conclusion: SWE variability in measurements was higher in phantoms embedded in TMM compared to those submerged in water. It is recommended that combine the transverse and longitudinal imaging planes to provide a better understanding of disease over the full vessel circumference.

Background: Diagnostic accuracy of double-contrast barium enema (DCBE) depends upon the barium sulfate coating efficiency in the colon. Objective: To evaluate effects of three laxatives on barium sulfate coating efficiency in the large intestine, sigmoid colon, and hepatic flexure in DCBE. Methods. This retrospective study included patients receiving DCBE after pre-procedure cleansing with Dulcolax^® with castor oil (DC), Klean-Prep^® (KP), or Fleet^® . Patients’DCBE images were reviewed. Results: Among 373 cases of DCBE, 151 received DC, 147 received KP, and 75 received Fleet. For DCBE, the optimal extent of barium sulfate residue coated on the wall of the large intestine is less than one-fourth of bowel wall width; the DC group had a higher percentage of less than one-fourth of bowel wall than that of the KP or Fleet group (both p < 0.0167). DC, KP and Fleet have comparable barium sulfate coating efficiency in the sigmoid colon. However, in the hepatic flexure, the DC group had a higher percentage of barium sulfate coating without interruption than that of the KP or Fleet groups (both p < 0.0167). Conclusion: DC has a better barium sulfate coating efficiency in the hepatic flexure compared with KP and Fleet.

Introduction: Chondrosarcomas are primary malignant bone tumor that rarely occurs in the head and neck region. Squash cytology of skull base neoplasm shows atypical chondrocytes and myxoid stroma, which suggests many possibilities like chordoma, chordoid glioma, chordoid meningioma and chondrosarcoma. Isocitrate dehydrogenase gene (IDH) mutations have been reported in 50% to 60% of the head and neck region chondrosarcoma. Case Presentation: A 37-year-old female came to the outpatient department and complaint of difficulty in walking and swaying to the right side for one year. The radiology was suggestive of right-sided trigeminal schwannoma. However, the squash cytology showed the presence of necrosis, and pink to bluish-coloured myxoid stroma. The tumor cells were pleomorphic and had a hyperchromatic nucleus, hyalinized condensed to granular cytoplasm. The histopathological examination of intraoperative soft tissue showed the presence of cellular lobules of atypical chondrocytes arranged in the myxoid background. The features were of Chondrosarcoma. No parenchymal invasion was found. Conclusion: This case report aims to create awareness about a rare tumor, which rarely forms a differential diagnosis for skull base neoplasms. As chondrosarcoma are immunoreactive to IDH1 so this marker can be useful in clinching the diagnosis in conjunction with other immunohistochemical markers in a small biopsy from skull base neoplasms.

Background: Pineal region solitary fibrous tumors (SFT) incorporate a histologic spectrum of rarely metastasizing mesenchymal neoplasms that include tumors formerly classified as hemangiopericytoma. Case Report: Here, we describe a rare case of SFT of the pineal region in a 25-year-old man with a literature review. After the first surgery, the tumor reappeared as a local low-grade recurrence, followed by metastasis to the right parietal lobe, and then hyperacute intraparenchymal hematoma at the metastatic site, and later presentation of widespread intracranial intra-axial and extra-axial metastases during the follow-up period. Systemic metastases were not detected. The histopathological evaluation of the resected tissues confirmed the malignant progression of the tumor. Conclusion: The diagnosis of SFT of the pineal region through clinical and imaging features can be considerably challenging. Large size, intratumoral cystic areas, and intense contrast enhancement are the main conventional imaging characteristics of the tumor. Surgery is the first preferential treatment. All recurrent or metastatic cases were grade II or grade III tumors. Adjuvant radiotherapy should be added to surgical treatment in high-grade tumors. Gamma knife radiosurgery is a treatment option for intracranial metastases.