Current Medical Imaging - Volume 20, Issue 1, 2024
Volume 20, Issue 1, 2024
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Study on the Prediction of Liver Injury in Acute Pancreatitis Patients by Radiomic Model Based on Contrast-Enhanced Computed Tomography
Authors: Lu Liu, Ningjun Yu, Tingting Liu, Shujun Chen, Yu Pu, Xiaoming Zhang and Xinghui LiObjectiveThis study aimed to predict liver injury in AP patients by establishing a radiomics model based on CECT.
MethodsA total of 1223 radiomic features were extracted from late arterial-phase pancreatic CECT images of 209 AP patients (146 in the training cohort and 63 in the test cohort), and the optimal radiomic features retained after dimensionality reduction by LASSO were used to construct a radiomic model through logistic regression analysis. In addition, clinical features were collected to develop a clinical model, and a joint model was established by combining the best radiomic features and clinical features to evaluate the practicality and application value of the radiomic models, clinical model, and combined model.
ResultsFour potential features were selected from the pancreatic parenchyma to construct the radiomic model, and the AUC of the radiomic model was significantly greater than that of the clinical model for both the training cohort (0.993 vs. 0.653, p = 0.000) and test cohort (0.910 vs. 0.574, p = 0.000). The joint model had a greater AUC than the radiomics model for both the training cohort (0.997 vs. 0.993, p = 0.357) and the test cohort (0.925 vs. 0.910, p = 0.302).
ConclusionThe radiomic model based on CECT has good performance in predicting liver injury in AP patients and can guide clinical decision-making and improve the prognosis of patients with AP.
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Comparison of the Performance of [18F]-FDG PET/CT and [18F]-FDG PET/MRI for Lymph Node Metastasis in Breast Cancer: A Systematic Review and Meta-Analysis
Authors: Suchi Han and Yanjing HuangObjectiveThe primary objective of this study was to conduct a comparative analysis of the diagnostic efficacy of [18F]-FDG PET/CT and [18F]-FDG PET/MRI in the detection of breast cancer lymph node metastasis.
MethodsWe conducted a comprehensive search on PubMed, Embase, and Web of Science databases, encompassing eligible articles until March 2023. The pooled sensitivity and specificity for [18F]-FDG PET/CT and [18F]-FDG PET/MRI have been reported as estimates with 95% Confidence Intervals (CIs) using a bivariate random-effect model. Utilizing the I square (I2) statistic, heterogeneity among pooled studies was evaluated. The quality assessment of the included studies was conducted using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) methodology.
ResultsWe included 18 studies (2057 patients). The sensitivity, specificity, and AUC (Area Under the Curve) values of [18F]-FDG PET/CT for overall lymph node metastasis in breast cancer have been found to be 0.58 (0.39 - 0.75), 0.83 (0.69-0.92), and 0.79 (0.75-0.82), respectively. Correspondingly, the values for [18F]-FDG PET/MRI were found to be 0.76 (0.60-0.88), 0.85 (0.77-0.91), and 0.89 (0.86-0.91), respectively. The sensitivity, specificity, and AUC values of [18F]-FDG PET/CT for axillary lymph node metastasis in breast cancer were 0.52 (0.37-0.67), 0.84 (0.68-0.92), and 0.73 (0.69-0.76), respectively. Correspondingly, the values for [18F]-FDG PET/MRI were 0.84 (0.76-0.89), 0.87 (0.75-0.94), and 0.86 (0.83-0.89), respectively.
ConclusionThis study has suggested [18F]-FDG PET/MRI to have greater diagnostic power than [18F]-FDG PET/CT in detecting lymph node metastasis in breast cancer. However, the [18F]-FDG PET/MRI results have been obtained from a small sample size study, and more and larger prospective studies are needed for further confirmation on this issue.
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Evaluation of an Algorithm for the Segmentation of Lung Nodules in Computerized Tomography Images based on the Automatic Location of a Threshold
Authors: Enguo Wang, Jun Li, Lei Liu and Yankun LiuBackgroundEarly detection of pulmonary nodules is critical for the clinical diagnosis and management of pulmonary nodules. Computed tomography imaging is currently the best imaging method for detecting pulmonary nodules.
ObjectiveThis study proposes and applies a new thresholding-based method for identifying pulmonary nodules in computed tomography images.
MethodsThe proposed method involves segmenting the lung volume and identifying candidate nodules based on their intensity levels, which are higher than those of the lung parenchyma. Reference points on the histogram curve are used to determine a threshold value, and filtering by geometric characteristics is applied to reduce false positives. The performance of the proposed method is evaluated on a training set consisting of 35 nodules distributed among 16 cases with ground truth using the SPIE-AAPM Lung CT Challenge Database and ELCAP Public Lung Image Database.
ResultsThe proposed method shows a significant reduction in false positives, filtering from an average of 12,380 candidate nodules to 19 detected nodules. The method also demonstrates a sensitivity of 88.6% for detecting pulmonary nodules with an error of 1 nodule in cases where complete detection is not reached.
ConclusionThe proposed thresholding-based method improves the sensitivity of identifying pulmonary nodules in computed tomography images while reducing false positives.
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Accurate Recognition of Vascular Lumen Region from 2D Ultrasound Cine Loops for Bubble Detection
Authors: Ziyi Wang, Zhuochang Yang, Ziye Chen, Xiaoyu Huang, Lifan Xu, Chang Zhou, Yingjie Zhou, Baoliang Zhu, Kun Zhang, Deren Gong, Weigang Xu and Jiangang ChenBackgroundAccurate identification of vascular lumen region founded the base of bubble detection and bubble grading, which played a significant role in the detection of vascular gas emboli for the diagnosis of decompression sickness.
ObjectiveTo assist in the detection of vascular bubbles, it is crucial to develop an automatic algorithm that could identify vascular lumen areas in ultrasound videos with the interference of bubble presence.
MethodsThis article proposed an automated vascular lumen region recognition (VLRR) algorithm that could sketch the accurate boundary between vessel lumen and tissues from dynamic 2D ultrasound videos. It adopts 2D ultrasound videos of the lumen area as input and outputs the frames with circled vascular lumen boundary of the videos. Normalized cross-correlation method, distance transform technique, and region growing technique were adopted in this algorithm.
ResultsA double-blind test was carried out to test the recognition accuracy of the algorithm on 180 samples in the images of 6 different grades of bubble videos, during which, intersection over union and pixel accuracy were adopted as evaluation metrics. The average IOU on the images of different bubble grades reached 0.76. The mean PA on 6 of the images of bubble grades reached 0.82.
ConclusionIt is concluded that the proposed method could identify the vascular lumen with high accuracy, potentially applicable to assist clinicians in the measurement of the severity of vascular gas emboli in clinics.
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Prostate Segmentation in MRI Images using Transfer Learning based Mask R-CNN
IntroductionThe second highest cause of death among males is Prostate Cancer (PCa) in America. Over the globe, it’s the usual case in men, and the annual PCa ratio is very surprising. Identical to other prognosis and diagnostic medical systems, deep learning-based automated recognition and detection systems (i.e., Computer Aided Detection (CAD) systems) have gained enormous attention in PCA.
MethodsThese paradigms have attained promising results with a high segmentation, detection, and classification accuracy ratio. Numerous researchers claimed efficient results from deep learning-based approaches compared to other ordinary systems that utilized pathological samples.
ResultsThis research is intended to perform prostate segmentation using transfer learning-based Mask R-CNN, which is consequently helpful in prostate cancer detection.
ConclusionLastly, limitations in current work, research findings, and prospects have been discussed.
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Improving Efficiency of Brain Tumor Classification Models Using Pruning Techniques
Authors: M. Sivakumar and S.T. PadmapriyaBackgroundThis research investigates the impact of pruning on reducing the computational complexity of a five-layered Convolutional Neural Network (CNN) designed for classifying MRI brain tumors. The study focuses on enhancing the efficiency of the model by removing less important weights and neurons through pruning.
ObjectiveThis research aims to analyze the impact of pruning on the computational complexity of a CNN for MRI brain tumor classification, identifying optimal pruning percentages to balance reduced complexity with acceptable classification performance.
MethodsThe proposed CNN model is implemented for the classification of MRI brain tumors. To reduce time complexity, weights and neurons of the trained model are pruned systematically, ranging from 0 to 99 percent. The corresponding accuracies for each pruning percentage are recorded to assess the trade-off between model complexity and classification performance.
ResultsThe analysis reveals that the model's weights can be pruned up to 70 percent while maintaining acceptable accuracy. Similarly, neurons in the model can be pruned up to 10 percent without significantly compromising accuracy.
ConclusionThis research highlights the successful application of pruning techniques to reduce the computational complexity of a CNN model for MRI brain tumor classification. The findings suggest that judicious pruning of weights and neurons can lead to a significant improvement in inference time without compromising accuracy.
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Implementation and Efficient Analysis of Preprocessing Techniques in Deep Learning for Image Classification
More LessBackground:Deep learning models have recently been preferred to perform certain image-processing tasks. Recently, with the increasing radiation, heat, and poor lighting conditions, the raw image samples may contain noisy and ambiguous information.
Objective:To process these images, the deep learning model requires a large number of data samples to learn the missing information from other clear data samples. This necessitates training the neural network with a huge dataset.
Methods:The researchers are now attempting to filter and improve such noisy images via preprocessing in order to provide valid and accurate feature information to the neural network layers. However, certain research studies claim that some useful information may be lost when the image is not preprocessed with an appropriate filter or enhancement technique. The MSA (meta-synthesis and analysis) approach is utilized in this work to present the impact of the image processing applications done with and without preprocessing steps. Also, this work summarizes the existing deep learning-based image processing models utilizing or not preprocessing steps in their implementation.
Results:This work has also found that 85% of the existing techniques involve a preprocessing step while developing a deep learning model. However, a maximum accuracy of 96.89% is observed on Sine-Net when it is implemented without a preprocessing and the same model gave 96.85% when implemented with preprocessing.
Conclusion:This research provides various research insights on the requirement and non-requirement of preprocessing steps in a deep learning-based implementation.
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MRI Imaging Appearance of Hyperostosis Frontalis Interna (HFI): A Case Report of Focal Benign Enhancement
Authors: Anish Bhandari, Mark Greenhill, Mayra Anthony, Sorabh Sharma and Raza MushtaqIntroduction:Hyperostosis frontalis interna (HFI) is a common and often incidental finding seen on imaging. There is a significant paucity of radiology literature, particularly regarding the MRI imaging appearance of HFI.
Case Presentation:We reported two cases of HFI on MRI, which showed focal enhancement. These were stable on long-term follow-up studies and thought to be most consistent with benign enhancement.
Conclusion:Further studies are needed to elucidate the underlying pathogenesis; however, it is important to be aware that regions of HFI may demonstrate variable enhancement and are sometimes mistaken for osseous metastatic disease.
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Feasibility Study on Constructing Dosimetric Correlated Geometric Parameters for Automatic Segmentation Evaluation
Authors: Yujie Zhang, Xin Zhou, Weixing Ji and Jianying ZhangPurposeTo investigate the feasibility of constructing new geometric parameters that correlate well with dosimetric parameters.
Methods100 rectal cancer patients were enrolled. The targets were identified manually, while the organs at risk (bladder, small bowel, left and right femoral heads) were segmented both manually and automatically. The radiotherapy plans were optimized according to the automatically contoured organs at risk. Forty cases were randomly selected to establish the relationship between dose and distance for each organ at risk, termed “dose-distance curves,” which were then applied to the new geometric parameters. The correlation between these new geometric parameters and dosimetric parameters was analyzed in the remaining 60 test cases.
ResultsThe “dose-distance curves” were similar across the four organs at risk, exhibiting an inverse function shape with a rapid decrease initially and a slower rate at a later stage. The Pearson correlation coefficients of new geometric parameters and dosimetric parameters in the bladder, small intestine, and left and right femur heads were 0.96, 0.97, 0.88, and 0.70, respectively.
ConclusionThe new geometric parameters predicated on “distance from the target” showed a high correlation with corresponding dosimetric parameters in rectal cancer cases. It is feasible to utilize the new geometric parameters to evaluate the dose deviation attributable to automatic segmentation.
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Assessment of Thermal and Mechanical Indices as Acoustic Output Parameters Used in Obstetric Ultrasound in Saudi Arabia
BackgroundPatient safety is paramount in ultrasound procedures, particularly in obstetric ultrasounds involving both the mother and fetus. The thermal and mechanical indices (TI and MI) serve as crucial indicators of the acoustic output during ultrasound. Clinicians and specialists must know these indices and ensure they are within safe ranges. This study aimed to assess the parameters of acoustic output power employed in obstetric ultrasound (thermal and mechanical index).
MethodologyA cross-sectional observational study conducted at Maternity and Children's Hospital in Al-Madinah Al-Munawwarah, the data was collected from obstetric scanning of 411 pregnant females using a data collection sheet including gravida and women's age, gestational age, scan mode, scan time, and thermal and mechanical index (TI and MI) values.
ResultsThe study found that there were significant differences in safety indices measurement between different modes; in Pulsed Doppler, mean Thermal Index Bone (TIb) had the highest value (1.60±0.40), and the Mechanical Index (MI) was the lowest (0.68±0.33). There were insignificant differences in safety indices values in different modes in different trimesters. The thermal indices of soft tissue and bony structure (TIs and TIb) of brightness mode (B-mode) were constant in all trimesters, but the MI in the first trimester was lower than in the other trimesters.
ConclusionThis study concluded that the mean values of thermal indices used in B mode , M mode and Color Doppler lie within the Recommended limit of (BMUS) British Medical Ultrasound Society (below 0.7) except for Pulsed Doppler it was exceed 1.5. While for MI in different ultrasound modes except in pulsed Doppler the average values is higher than 0.7 which was recommended by (BMUS) British Medical Ultrasound Society and lower than 1.9 which was the maximum threshold approved by FDA (Food and drug Administration). The average scanning time is low (6.4 minute) reflect the safe use of ultrasound in obstetrics in this study.
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A Clinical-radiomics Nomogram for the Non-invasive Evaluation of Glomerular Status in Diabetic Kidney Disease
Authors: Weihan Xiao, Di Zhang, Xiaomin Hu, Chen Yin, Xiaoling Liu, Di Wang, Jiao Yao, Xuebin Liu, Chaoxue Zhang and Xiachuan QinObjectiveUtilizing ultrasound radiomics, we developed a machine learning (ML) model to construct a nomogram for the non-invasive evaluation of glomerular status in diabetic kidney disease (DKD).
Materials and MethodsPatients with DKD who underwent renal biopsy were retrospectively enrolled between February 2017 and February 2023. The patients were classified into mild or moderate-severe glomerular severity based on pathological findings. All patients were randomly divided into a training (n = 79) or testing cohort (n = 35). Radiomics features were extracted from ultrasound images, and a logistic regression ML algorithm was applied to construct an ultrasound radiomic model after selecting the most significant features using univariate analysis and the least absolute shrinkage and selection operator algorithm (LASSO). A clinical model was created following univariate and multivariate logistic regression analyses of the patient's clinical characteristics. Then, the clinical-radiomics model was constructed by combining rad scores and independent clinical characteristics and plotting the nomogram. The receiver operating characteristic curve (ROC) and decision curve analysis (DCA), respectively, were used to evaluate the prediction abilities of the clinical model, ultrasound-radiomics model, and clinical-radiomics model.
ResultsA total of 114 DKD patients were included in the study, including 43 with mild glomerulopathy and 71 with moderate-severe glomerulopathy. The area under the curve (AUC) for the clinical model based on clinical features and the radiomic model based on 2D ultrasound images in the testing cohort was 0.729 and 0.761, respectively. Further, the AUC for the clinical-radiomics nomogram was constructed by combining clinical features, and the rad score was 0.850 in the testing cohort. The outcomes were better than those of both the radiomic and clinical single-model approaches.
ConclusionThe nomogram constructed by combining ultrasound radiomics and clinical features has good performance in assessing the glomerular status of patients with DKD and will help clinicians monitor the progression of DKD.
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Hypersensitivity Reactions Induced by Iodinated Contrast Media in Radiological Diagnosis: A Disproportionality Analysis Based on the FAERS Database
Authors: Jinjin Long, Yifan Ji, Yawen Zhang and Xinghui LiPurposeThis study aimed to evaluate the Pharmacovigilance (PV) and severity of hypersensitivity reactions induced by non-ionic Iodinated Contrast Media (ICM) in the radiology diagnosis reported to the United States Food and Drug Administration Adverse Event Reporting System (FAERS).
MethodsWe retrospectively reviewed the reports of ICM-induced hypersensitivity reactions submitted to the FAERS database between January 2015 and January 2023 and conducted a disproportionality analysis. The seven most common non-ionic ICM, including iohexol, iopamidol, ioversol, iopromide, iomeprol, iobitridol, and iodixanol, were chiefly analyzed. Our primary endpoint was the PV of non-ionic ICM-induced total hypersensitivity events. STATA 17.0 MP was used for statistical analysis.
ResultsIn total, 35357 reports of adverse reaction events in radiology diagnosis were retrieved from the FAERS database. Among them, 6181 reports were on hypersensitivity reaction events (mean age: 57.1 ± 17.8 years). The hypersensitivity reaction-related PV signal was detected for iohexol, ioversol, iopromide, iomeprol, iobitridol, and iodixanol, but not for iopamidol. The proportion of iomeprol-induced hypersensitivity reactions and the probability of ioversol-induced severe hypersensitivity reactions have been found to be significantly increased.
ConclusionThe probability and severity of hypersensitivity reaction events in non-ionic ICM are different. Iohexol, ioversol, iopromide, iomeprol, iobitridol, and iodixanol have higher risks compared to iopamidol. In addition, the constituent ratio of hypersensitivity reactions induced by iomeprol is significantly increased, and the associated probability induced by ioversol is significantly increased.
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Enhancing Alzheimer's Disease Classification with Transfer Learning: Fine-tuning a Pre-trained Algorithm
Authors: Abdelmounim Boudi, Jingfei He and Isselmou Abd El KaderObjectiveThe increasing longevity of the population has made Alzheimer's disease (AD) a significant public health concern. However, the challenge of accurately distinguishing different disease stages due to limited variability within the same stage and the potential for errors in manual classification highlights the need for more precise approaches to classifying AD stages. In the field of deep learning, the ResNet50V2 model stands as a testament to its exceptional capabilities in image classification tasks.
MaterialsThe dataset employed in this study was sourced from Kaggle and consisted of 6400 MRI images that were meticulously collected and rigorously verified to assure their precision. The selection of images was conducted with great attention to detail, drawing from a diverse array of sources.
MethodsThis study focuses on harnessing the potential of this model for AD classification, a task that relies on extracting disease-specific features. Furthermore, to achieve this, a multi-class classification methodology is employed, using transfer learning and fine-tuning of layers to adapt the pre-trained ResNet50V2 model for AD classification. Notably, the impact of various input layer sizes on model performance is investigated, meticulously striking a balance between capacity and computational efficiency. The optimal fine-tuning strategy is determined by counting layers within convolution blocks and selectively unfreezing and training individual layers after a designated layer index, ensuring consistency and reproducibility. Custom classification layers, dynamic learning rate reduction, and extensive visualization techniques are incorporated.
ResultsThe model's performance is evaluated using accuracy, AUC, precision, recall, F1-score, and ROC curves. The comprehensive analysis reveals the model's ability to discriminate between AD stages. Visualization through confusion matrices aided in understanding model behavior. The rounded predicted labels enhanced practical utility.
ConclusionThis approach combined empirical research and iterative refinement, resulting in enhanced accuracy and reliability in AD classification. Our model holds promise for real-world applications, achieving an accuracy of 96.18%, showcasing the potential of deep learning in addressing complex medical challenges.
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A Dynamic Context Encoder Network for Liver Tumor Segmentation
Authors: Jun Liu, Jing Fang, Tao Jiang, Chaochao Zhou, Liren Shao and Yusheng SongBackground:Accurate segmentation of liver tumor regions in medical images is of great significance for clinical diagnosis and the planning of surgical treatments. Recent advancements in machine learning have shown that convolutional neural networks are powerful in such image processing while largely reducing human labor. However, the variable shape, fuzzy boundary, and discontinuous tumor region of liver tumors in medical images bring great challenges to accurate segmentation. The feature extraction capability of a neural network can be improved by expanding its architecture, but it inevitably demands more computing resources in training and hyperparameter tuning.
Methods:This study presents a Dynamic Context Encoder Network (DCE-Net), which incorporates multiple new modules, such as the Involution Layer, Dynamic Residual Module, Context Extraction Module, and Channel Attention Gates, for feature extraction and enhancement.
Results:In the experiment, we used a liver tumor CT dataset of LiTS2017 to train and test the DCE-Net for liver tumor segmentation. The experimental results showed that the four evaluation indexes of the method, precision, recall, dice, and AUC, were 0.8961, 0.9711, 0.9270, and 0.9875, respectively. Furthermore, our ablation study reported that the accuracy and training efficiency of our network were markedly superior to the networks without involution or dynamic residual modules.
Conclusion:Therefore, the DCE-Net proposed in this study has great potential for automatic segmentation of liver lesion tumors in the clinical diagnostic environment.
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Assessment of Left Ventricular Diastolic Function in Patients with Diffuse Large B-cell Lymphoma after Anthracycline Chemotherapy by using Vector Flow Mapping
Authors: Kun Yang, Jia Hu, Xinchun Yuan, Yu Xiahou and Ping RenBackgroundPatients with diffuse large B-cell lymphoma (DLBCL) often experience a poor prognosis due to cardiac damage induced by anthracycline chemotherapy, with left ventricular diastolic dysfunction manifesting early. Vector Flow Mapping (VFM) is a novel technology, and its effectiveness in detecting left ventricular diastolic dysfunction following anthracycline chemotherapy remains unverified.
ObjectThis study evaluates left ventricular diastolic function in DLBCL patients after anthracycline chemotherapy using vector flow mapping (VFM).
Materials and MethodsWe prospectively enrolled 54 DLBCL patients who had undergone anthracycline chemotherapy (receiving a minimum of 4 cycles) as the case group and 54 age- and sex-matched individuals as controls. VFM assessments were conducted in the case group pre-chemotherapy (T0), post-4 chemotherapy cycles (T4), and in the control group. Measurements included basal, middle, and apical segment energy loss (ELb, ELm, ELa) and intraventricular pressure differences (IVPDb, IVPDm, IVPDa) across four diastolic phases: isovolumic relaxation (D1), rapid filling (D2), slow filling (D3), and atrial contraction (D4).
ResultsWhen comparing parameters between the control and case groups at T0, no significant differences were observed in general data, conventional ultrasound parameters, and VFM parameters (all P > 0.05). From T0 to T4, ELa significantly increased throughout the diastole cycle (all P < 0.05); ELm increased only during D4 (all P < 0.05); and ELb increased during D1, D2, and D4 (all P < 0.05). All IVPD measurements (IVPDa, IVPDm, IVPDb) increased during D1 and D4 (all P < 0.05) but decreased during D2 and D3 (all P < 0.05). Significant positive correlations were identified between ELa-D4, IVPDa-D4, and parameters A, e’, E/e,’ and LAVI (all r > 0.5, all P < 0.001). Negative correlations were noted with E/A for ELa-D4 IVPDa-D4 (all r < -0.5, all P < 0.001). Positive correlations were observed for IVPDa-D1, IVPDa-D2 with E, E/e’, and LAVI (0.3
ConclusionVFM parameters demonstrate a certain correlation with conventional diastolic function parameters and show promise in assessing left ventricular diastolic function. Furthermore, VFM parameters exhibit greater sensitivity to early diastolic function changes, suggesting that VFM could be a novel method for evaluating differences in left ventricular diastolic function in DLBCL patients before and after chemotherapy.
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Puerarin Affects 1HMR Spectroscopy Quantified Hepatic Fat Signal Fraction in Intrauterine Growth Restricted Rats
Authors: Tao Wang, Alpha Kalonda Mutamba, Jing Bian, Xiaori He and DuJun BianObjective:This study aimed to investigate the impact of puerarin early intervention on growth parameters and Hepatic Fat Signal Fraction (HFF) quantification in Intrauterine Growth Restricted (IUGR) rats through Proton Magnetic resonance spectroscopy (1H-MRS).
Methods:Pregnant rats were divided into three groups: control, IUGR with puerarin treatment, and IUGR without treatment. The treatment and non-treatment groups were received a low-protein diet during pregnancy, while the control group received a normal diet. After birth, pups in the treatment group received a unilateral intraperitoneal injection of 50 mg/kg/d puerarin. Male rats were evaluated at 3,8 and 12 weeks, including measurements of weight, body length and waist circumference and body mass index (BMI). Conventional magnetic resonance imaging and 1H-MRS were conducted using a 3.0 T whole-body MR scanner.
Results:Newborn pups in the treatment and non-treatment groups showed significantly lower body weight, BMI, and body length at 3 weeks compared to the control group. However, there were no significant differences in HFF and waist circumference between the three groups at 3 weeks. At 8 and 12 weeks post-delivery, significant differences in body weight, BMI, waist circumference were observed in newborn pups of IUGR non-treatment rats compared to the control group. In contrast, there were no significant differences in body weight, BMI, waist circumference between the treatment group and the control group at 8 and 12 weeks. Moreover, the treatment group exhibited notably higher HFF compared to the control group at both time points. At 12 weeks post-birth, a significant difference in HFF was observed between the IUGR non-treatment and treatment groups, although no significant difference was found at 8 weeks.
Conclusion:Early intervention with puerarin following birth has a significant impact on liver fat content and may potentially reduce adult obesity among IUGR rats.
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Automatic Optic Nerve Assessment From Transorbital Ultrasound Images: A Deep Learning-based Approach
By Youping XiaoBackgroundTransorbital Ultrasonography (TOS) is a promising imaging technology that can be used to characterize the structures of the optic nerve and the potential alterations that may occur in those structures as a result of an increase in intracranial pressure (ICP) or the presence of other disorders such as multiple sclerosis (MS) and hydrocephalus.
ObjectiveIn this paper, the primary objective is to develop a fully automated system that is capable of segmenting and calculating the diameters of structures that are associated with the optic nerve in TOS images. These structures include the optic nerve diameter sheath (ONSD) and the optic nerve diameter (OND).
MethodsA fully convolutional neural network (FCN) model that has been pre-trained serves as the foundation for the segmentation method. The method that was developed was utilized to collect 464 different photographs from 110 different people, and it was accomplished with the assistance of four distinct pieces of apparatus.
ResultsAn examination was carried out to compare the outcomes of the automatic measurements with those of a manual operator. Both OND and ONSD have a typical inaccuracy of -0.12 0.32 mm and 0.14 0.58 mm, respectively, when compared to the operator. The Pearson correlation coefficient (PCC) for OND is 0.71, while the coefficient for ONSD is 0.64, showing that there is a positive link between the two measuring tools.
ConclusionA conclusion may be drawn that the technique that was developed is automatic, and the average error (AE) that was reached for the ONSD measurement is compatible with the ranges of inter-operator variability that have been discovered in the literature.
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SkinLiTE: Lightweight Supervised Contrastive Learning Model for Enhanced Skin Lesion Detection and Disease Typification in Dermoscopic Images
More LessIntroduction:This study introduces SkinLiTE, a lightweight supervised contrastive learning model tailored to enhance the detection and typification of skin lesions in dermoscopic images. The core of SkinLiTE lies in its unique integration of supervised and contrastive learning approaches, which leverages labeled data to learn generalizable representations. This approach is particularly adept at handling the challenge of complexities and imbalances inherent in skin lesion datasets.
Methods:The methodology encompasses a two-phase learning process. In the first phase, SkinLiTE utilizes an encoder network and a projection head to transform and project dermoscopic images into a feature space where contrastive loss is applied, focusing on minimizing intra-class variations while maximizing inter-class differences. The second phase freezes the encoder's weights, leveraging the learned representations for classification through a series of dense and dropout layers. The model was evaluated using three datasets from Skin Cancer ISIC 2019-2020, covering a wide range of skin conditions.
Results:SkinLiTE demonstrated superior performance across various metrics, including accuracy, AUC, and F1 scores, particularly when compared with traditional supervised learning models. Notably, SkinLiTE achieved an accuracy of 0.9087 using AugMix augmentation for binary classification of skin lesions. It also showed comparable results with the state-of-the-art approaches of ISIC challenge without relying on external data, underscoring its efficacy and efficiency. The results highlight the potential of SkinLiTE as a significant step forward in the field of dermatological AI, offering a robust, efficient, and accurate tool for skin lesion detection and classification. Its lightweight architecture and ability to handle imbalanced datasets make it particularly suited for integration into Internet of Medical Things environments, paving the way for enhanced remote patient monitoring and diagnostic capabilities.
Conclusion:This research contributes to the evolving landscape of AI in healthcare, demonstrating the impact of innovative learning methodologies in medical image analysis.
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Diagnostic Study of Nodular Pulmonary Cryptococcosis Based on Radiomic Features Captured from CT Images
Authors: Danmei Huang, Xiuting Wu, Siqi Chen, Kai Li, Xiaobo Zhang, Xiaoyu Pan, Liang Fu, Wenjun Lin, Zefeng Li and Xuechun GuanBackgroundRadiomics can quantify pulmonary nodule characteristics non-invasively by applying advanced imaging feature algorithms. Radiomic textural features derived from Computed Tomography (CT) imaging are broadly used to predict benign and malignant pulmonary nodules. However, few studies have reported on the radiomics-based identification of nodular Pulmonary Cryptococcosis (PC).
ObjectiveThis study aimed to evaluate the diagnostic and differential diagnostic value of radiomic features extracted from CT images for nodular PC.
MethodsThis retrospective analysis included 44 patients with PC (29 males, 15 females), 58 with Tuberculosis (TB) (39 males, 19 females), and 60 with Lung Cancer (LC) (20 males, 40 females) confirmed pathologically. Models 1 (PC vs. non-PC), 2 (PC vs. TB), and 3 (PC vs. LC) were established using radiomic features. Models 4 (PC vs. TB) and 5 (PC vs. LC) were established based on radiomic and CT features.
ResultsFive radiomic features were predictive of PC vs. non-PC model, but accuracy and Area Under the Curve (AUC) were 0.49 and 0.472, respectively. In model 2 (PC vs. TB) involving six radiomic features, the accuracy and AUC were 0.80 and 0.815, respectively. Model 3 (PC vs. LC) with six radiomic features performed well, with AUC=0.806 and an accuracy of 0.76. Between the PC and TB groups, model 4 combining radiomics, distribution, and PI, showed AUC=0.870. In differentiating PC from LC, the combination of radiomics, distribution, PI, and RBNAV achieved AUC=0.926 and an accuracy of 0.90.
ConclusionThe prediction models based on radiomic features from CT images performed well in discriminating PC from TB and LC. The individualized prediction models combining radiomic and CT features achieved the best diagnostic performance.
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Ultrasonographic Evaluation of Juvenile Localized Scleroderma: Enhancing Objectivity in Diagnosis and Management
Authors: Şeyma Türkmen, Gülşah Pirim and Betül SözeriBackgroundAlthough clinical assessment has historically been the primary method used for diagnosing and staging pediatric localized scleroderma (LS), high-frequency ultrasonography (HFUS) is being investigated as a more accurate method for evaluating lesions.
ObjectivesThis study aimed to assess, compare dermal and subcutaneous tissue characteristics and enhance lesion staging in pediatric LS patients using HFUS.
MethodsTwenty two LS patients were cross-sectionally evaluated with B-mode ultrasonography. Lesions were clinically staged, and dermal and subcutaneous tissue characteristics were compared with healthy tissue using HFUS.
ResultsAmong 55 lesions, 27 were active/new (49.1%), and 28 were atrophic/old (50.9%). Active lesions typically had increased dermal thickness in 66.6% of cases, while atrophic lesions often showed decreased dermal thickness (78.5%), with significant differences (p<0.05). Dermal echogenicity decreased in 40.7% of active lesions but remained largely unchanged in atrophic lesions (82.1%) (p<0.05). Subcutaneous tissue thickness significantly decreased in atrophic lesions (78.5%) and increased in 59.2% of active lesions, with a significant difference (p = 0.002). Subcutaneous tissue echogenicity increased in 44.4% of active lesions and remained mostly unchanged in atrophic lesions (67.8%). Importantly, a considerable proportion of lesions diagnosed as active through physical examination were actually inactive on HFUS evaluation (55.6%), while a significant portion of lesions categorized as atrophic on physical examination displayed areas of inactivity upon ultrasonographic assessment (35.7%). These findings highlight HFUS's potential as a valuable diagnostic tool and reveal discordances between clinical and HFUS staging.
ConclusionUltrasonography offers an objective LS lesion evaluation, especially in pediatrics.
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Can Gender-Specific Renal and Visceral Fat Evaluated by CT Predict the Fuhrman Nuclear Classification of Clear Cell Renal Cell Carcinoma?
Authors: Xiaoxia Li, Jinglai Lin, Yi Guo, Dengqiang Lin and Jianjun ZhouBackgroundEvidence of the association between obesity and renal cell carcinoma progression is contradictory. The effects of renal cell carcinoma on fat distribution are still unknown.
ObjectiveThe goal of this study was to determine the ability of various forms of fat deposition to predict the Fuhrman nuclear grade of clear cell renal cell carcinoma [ccRCC].
MethodsThis retrospective study included 320 patients with pathologically proven ccRCC [215 men and 105 women; 263 low-grade ccRCC and 57 high-grade ccRCC]. Based on computed tomography scans, adipose tissue in various body regions was classified into the perirenal fat area [PFA], visceral fat area [VFA], total fat area [TFA], subcutaneous fat area [SFA], and hepatic steatosis [HS]. Subsequently, the relative VFA [rVFA] was computed. Age, sex, body mass index, and maximal tumor diameter were also regarded as clinical factors. Univariate and multivariate logistic regression studies were conducted to evaluate whether there was an association between body fat composition and the Fuhrman classification and whether it was related to gender.
ResultsAfter correcting for age, males with low-grade ccRCC exhibited higher TFA [257.6 vs. 203.0, p = 0.002], VFA [151.6 vs.115.5, p = 0.007], SFA [106.0 vs. 87.5, p = 0.015], PFA [55.1 vs. 30.4, p < 0.001], and HS [18% vs. 0%, p = 0.031] than those with high-grade ccRCC. There was no significant difference among rVFA in males. In females, there was no significant difference in any of the parameters. VFA and PFA remained independent predictors for high-grade ccRCC in males in both the monovariate [VFA: odds ratio [OR] 0.992, 95% confidence interval [CI] 0.987–0.997, p = 0.004; PFA: OR 0.949, 95% CI 0.930–0.970, p < 0.001] and multivariate [VFA: OR 1.028, 95% CI 1.001–1.074, p < 0.001; PFA: OR 0.878, 95% CI 0.833–0.926, p < 0.001] models.
ConclusionGender-specific adipose tissue in different locations demonstrated varied values for predicting high-grade ccRCC and may be utilized as an independent predictor of high-grade ccRCC in male patients.
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Clinical Presentations and Intense FDG-avidity in Pulmonary Angiomatoid Fibrous Histiocytoma with Potential Diagnostic Pitfalls: A Case Report and Literature Review
Authors: Xiu-Qin Luo, Wan-Ling Qi, Qian Liu, Qing-Yun Zeng and Zhe-Huang LuoIntroductionAngiomatoid fibrous histiocytoma (AFH) is a borderline tumor usually affecting the the children or young adults. 18F-Fluorodexoyglucose (FDG) positron emission tomography/computed tomography (PET/CT) investigations of pulmonary AFH are rare, and there are currently no reports of intense FDG uptake in AFH.
Case ReportWe report an AFH that occurred in the lung of a 57-year-old woman. She presented with paroxysmal cough and occasional bloodshot sputum. 18F-FDG PET/CT revealed a right parahilar nodule with intense FDG-avidity, middle lobe atelectasis, and several bilateral axillary lymph nodes with mild hypermetabolic activity. This patient underwent a right middle lobe lobectomy via video-assisted thoracoscopy. Histopathologically, the diagnosis was pulmonary AFH. She had an uneventful postoperative course, and the bilateral axillary lymph nodes regressed during postoperative follow-up.
ConclusionsThe clinical presentation and image findings of patients with primary pulmonary AFH may be potential diagnosis pitfalls. The diagnosis of lymph nodes or distant metastases should be approached with caution. To avoid misdiagnosis, biopsy with histological examination and immunohistochemichal staining should be performed as early as possible.
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An Artificial Intelligence Driven Approach for Classification of Ophthalmic Images using Convolutional Neural Network: An Experimental Study
BackgroundEarly disease detection is emphasized within ophthalmology now more than ever, and as a result, clinicians and innovators turn to deep learning to expedite accurate diagnosis and mitigate treatment delay. Efforts concentrate on the creation of deep learning systems that analyze clinical image data to detect disease-specific features with maximum sensitivity. Moreover, these systems hold promise of early accurate diagnosis and treatment of patients with common progressive diseases. DenseNet, ResNet, and VGG-16 are among a few of the deep learning Convolutional Neural Network (CNN) algorithms that have been introduced and are being investigated for potential application within ophthalmology.
MethodsIn this study, the authors sought to create and evaluate a novel ensembled deep learning CNN model that analyzes a dataset of shuffled retinal color fundus images (RCFIs) from eyes with various ocular disease features (cataract, glaucoma, diabetic retinopathy). Our aim was to determine (1) the relative performance of our finalized model in classifying RCFIs according to disease and (2) the diagnostic potential of the finalized model to serve as a screening test for specific diseases (cataract, glaucoma, diabetic retinopathy) upon presentation of RCFIs with diverse disease manifestations.
ResultsWe found adding convolutional layers to an existing VGG-16 model, which was named as a proposed model in this article that, resulted in significantly increased performance with 98% accuracy (p<0.05), including good diagnostic potential for binary disease detection in cataract, glaucoma, diabetic retinopathy.
ConclusionThe proposed model was found to be suitable and accurate for a decision support system in Ophthalmology Clinical Framework.
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Precancerous Change Detection Technique on Mammography Breast Cancer Images based on Mean Ratio and Log Ratio using Fuzzy c Mean Classification with Gabor Filter
Authors: Razia Jamil, Min Dong, Shahzadi Bano, Arifa Javed and Muhammad AbdullahBackgroundThe growing rate of breast cancer necessitates immediate global attention. Mammography images are used to determine the stage of malignancy. Breast cancer stages must be identified in order to save a person's life.
ObjectiveThis article's main goal is to identify different techniques to obtain the difference between two breast cancer mammography images taken of the same individual at different times. This is the first effort to identify breast cancer in mammography images using change detection techniques. The Mammogram Image Change Detection (ICD) technique is also a recent advancement to prevent breast cancer in the early stage and precancerous level in medical images.
MethodsThe main purpose of this work is to observe the changes between breast cancer images in different screening periods using different techniques. Mammogram Breast Cancer Image Change Detection (MBCICD) methods usually start with a Difference Image (DI) and classify the pixels in the DI into changed and unaffected classes using unsupervised fuzzy c means (FCM) clustering methods based on texture features taken from the log and mean ratio difference pictures. Two operators, mean ratio and log ratio, were used to check the changes in the images. The Gabor wavelet is utilized as a feature extraction technique among several standards. Using the Gabor wavelet ratio operators is a useful method for altering the detection of breast cancer in mammography images. Currently, it is challenging to obtain real malignant images of the same person for testing or training. In this study, two images are utilized. To clearly see the changes, one is an image from the MIAS breast cancer mammography images dataset, and the other is a self-generated change image.
ResultsThe research aims to examine the image results and other quantitative analysis results of proposed change detection methods on cancer images. The Mean Ratio Accuracy result is 0.9738, and the Log ratio PCC is 0.9737. The classification results are the Log Ratio + Gabor Filter + FCM is 0.9737, and Mean Ratio +Gabor Filter + FCM is 0.9719. The mean Ratio Accuracy result is 0.9738, Log ratio is 0.9737. Log Ratio + Gabor Filter + FCM is 0.9737, Mean Ratio +Gabor Filter + FCM is 0.9719. Comparing the PCC of proposed change detection methods with the FDA-RMG method on the same dataset, the accuracy is 0.9481 only.
ConclusionThe study concludes that variations in mammography breast cancer images could be successfully identified using the ratio operators with Gabor wavelet features.
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Use of MRI Radiomics Models in Evaluating the Low HER2 Expression in Breast Cancer
Authors: Hao Li, Yan Hou, Lin-Yan Xue, Wen-Long Fan, Bu-Lang Gao and Xiao-Ping YinObjectiveTo investigate the magnetic resonance imaging (MRI) radiomics models in evaluating the human epidermal growth factor receptor 2(HER2) expression in breast cancer.
Materials and MethodsThe MRI data of 161 patients with invasive ductal carcinoma (non-special type) of breast cancer were retrospectively collected, and the MRI radiomics models were established based on the MRI imaging features of the fat suppression T2 weighted image (T2WI) sequence, dynamic contrast-enhanced (DCE)-T1WIsequence and joint sequences. The T-test and the least absolute shrinkage and selection operator (LASSO) algorithm were used for feature dimensionality reduction and screening, respectively, and the random forest (RF) algorithm was used to construct the classification model.
ResultsThe model established by the LASSO-RF algorithm was used in the ROC curve analysis. In predicting the low expression state of HER2 in breast cancer, the radiomics models of the fat suppression T2WI sequence, DCE-T1WI sequence, and the combination of the two sequences showed better predictive efficiency. In the receiver operating characteristic (ROC) curve analysis for the verification set of low, negative, and positive HER2 expression, the area under the ROC curve (AUC) value was 0.81, 0.72, and 0.62 for the DCE-T1WI sequence model, 0.79, 0.65 and 0.77 for the T2WI sequence model, and 0.84, 0.73 and 0.66 for the joint sequence model, respectively. The joint sequence model had the highest AUC value.
ConclusionsThe MRI radiomics models can be used to effectively predict the HER2 expression in breast cancer and provide a non-invasive and early assistant method for clinicians to formulate individualized and accurate treatment plans.
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Fibrosarcomatous Transformation in Dermatofibrosarcoma Protuberans of the Male Breast and its Association with Magnetic Resonance Imaging and Immunohistopathologic Features
Authors: Sang Yull Kang, Eun Jung Choi and Kyu Yun JangBackground:Dermatofibrosarcoma Protuberans (DFSP) is a rare soft tissue sarcoma, accounting for approximately 1% of all tumors; however, DFSP of the breast is extremely rare. Moreover, DFSP generally has a low malignant potential and is characterized by a high rate of local recurrence along with a small but definite risk of metastasis. The risk of metastasis is higher in fibrosarcomatous transformation in DFSP than in ordinary DFSP.
Case Report:We have, herein, reported a case of a 61-year-old male patient with fibrosarcomatous transformation in DFSP. Preoperative Dynamic Contrast-enhanced Magnetic Resonance Imaging (DCE-MRI) of the breast revealed an oval-shaped mass with heterogeneous internal enhancement, a large vessel embedded within, and a washout curve pattern on kinetic curve analysis. The mass exhibited a hyperintense signal on Diffusion-weighted Imaging (DWI), with a low apparent diffusion coefficient value. Histologically, the bland spindle tumor cells were arranged in a storiform pattern. Areas with the highest histological grade demonstrated increased cellularity, cytological atypia, and mitotic activity. Immunohistochemically, Ki-67 and p53 were highly expressed.
Conclusion:Recognizing the risk and accurately diagnosing fibrosarcomatous transformation in male breast DFSP are critical for improving prognosis and establishing appropriate treatment and follow-up plans. This emphasizes the significance of combining immunohistopathological features with DCE-MRI and DWI to assist clinicians in the early and accurate diagnosis of sarcomas arising from male breast DFSP.
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Integrating Tumor and Nodal Radiomics to Predict the Response to Neoadjuvant Chemotherapy and Recurrence Risk for Locally Advanced Gastric Cancer
Authors: Shimei Han, Xiaomeng Han, Yaolin Song, Ruiqing Liu, Hexiang Wang, Zaixian Zhang, Bohua Yu, Zhiming Li and Shunli LiuAimsTo develop and evaluate machine learning models using tumor and nodal radiomics features for predicting the response to neoadjuvant chemotherapy (NAC) and recurrence risk in locally advanced gastric cancer (LAGC).
BackgroundEarly and accurate response prediction is vital to stratify LAGC patients and select proper candidates for NAC.
ObjectiveA total of 218 patients with LAGC undergoing NAC followed by gastrectomy were enrolled in our study and were randomly divided into a training cohort (n = 153) and a validation cohort (n = 65).
MethodsWe extracted 1316 radiomics features from the volume of interest of the primary lesion and maximal lymph node on venous phase CT images. We built 3 radiomics signatures for distinguishing good responders and poor responders based on tumor radiomics (TR), nodal radiomics (NR), and a combination of the two (TNR), respectively. A nomogram was then developed by integrating the radiomics signature and clinical factors. Kaplan-Meier survival curves were used to evaluate the prognostic value of the nomogram.
ResultsThe TNR signature achieved improved predictive value, with AUCs of 0.755 and 0.744 in the training and validation cohorts. Our proposed nomogram model (TNRN) showed a good performance for GR prediction in the prediction efficacy, calibration ability, and clinical benefit, with AUCs of 0.779 and 0.732 in the training and validation cohorts, superior to the clinical model. Moreover, the TNRN could accurately classify the patients into high-risk and low-risk groups in both training and validation cohorts with regard to postoperative recurrence and metastasis.
ConclusionThe TNRN performed well in identifying good responders and provided valuable information for predicting progression-free survival time (PFS) in patients with LAGC who underwent NAC.
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Paracetamol-induced Liver Injury in An Experimental Rat Model: Noninvasive Assessment using DKI and the Effect of Gadoxetate on DKI Parameters
Authors: Lixue Xu, Dawei Yang, Dan Chen, Hui Xu, Jing Zheng, Tianxin Cheng, Hao Ren, Yan Wang, Xinyan Zhao and Zhenghan YangPurposeTo explore the potential of diffusion kurtosis imaging (DKI) for assessing the degree of liver injury in a paracetamol-induced rat model and to simultaneously investigate the effect of intravenous gadoxetate on DKI parameters.
MethodsParacetamol was used to induce hepatoxicity in 39 rats. The rats were pathologically classified into 3 groups: normal (n=11), mild necrosis (n=18), and moderate necrosis (n=10). DKI was performed before and, 15 min, 25 min, and 45 min after gadoxetate administration. Repeated-measures ANOVA with Tukey’s multiple comparison test was used to investigate the effect of gadoxetate on mean diffusivity (MD) and mean diffusion kurtosis (MK) and to assess the differences in MD and MK among the three groups. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic accuracy of the MD values when discriminating between the necrotic groups.
ResultsGadoxetate had no significant effect on either the MD or the MK, and the effect size was small. The MD in the moderate necrosis group was significantly lower than that in the other two groups (F = 13.502, p <0.001; η2 = 0.428 [95% CI: 0.082-0.637]), while the MK did not significantly differ among the three groups (F = 2.702, p = 0.081; η2 = 0.131 [95% CI: 0.001-0.4003]). The AUCs of MD for discriminating the moderate necrosis or normal group from the other groups were 0.921 (95% CI: 0.832-1.000) and 0.831 (95% CI: 0.701-0.961), respectively.
ConclusionIt would be better to measure the MD and MK before gadoxetate injection. MD showed potential for assessing the degree of liver necrosis in a paracetamol-induced liver injury rat model.
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A Preoperative Prediction Model for Lymph Node Metastasis in Patients with Gastric Cancer using a Machine Learning-based Ultrasomics Approach
Authors: Weiwei Lin, Qi Zhong, Jingjing Guo, Shanshan Yu, Kunhuang Li, Qingling Shen, Minling Zhuo, EnSheng Xue, Peng Lin and Zhikui ChenObjectiveThis study aims to develop an ultrasomics model for predicting lymph node metastasis in patients with gastric cancer (GC).
MethodsThis study enrolled GC patients who underwent preoperative ultrasound examination. Manual segmentation of the region of interest (ROI) was performed by an experienced radiologist to extract radiomics features using the Pyradiomics software. The Z-score algorithm was used for feature normalization, followed by the Wilcoxon test to identify the most informative features. Linear prediction models were constructed using the least absolute shrinkage and selection operator (LASSO). The performance of the ultrasomics model was evaluated using the area under curve (AUC), sensitivity, specificity, and the corresponding 95% confidence intervals (CIs).
ResultsA total of 464 GC patients (mean age: 60.4 years ±11.3 [SD]; 328 men [70.7%]) were analyzed, of whom 291 had lymph node metastasis. The patients were randomly assigned to either the training (n=324) or test (n=140) sets, using a 7:3 ratio. An ultrasomics model that consisted of 19 radiomics features was developed using Wilcoxon and LASSO algorithms in the training set. Our ultrasomics model showed moderate performance for lymph node metastasis prediction in both the training (AUC: 0.802, 95% CI: 0.752-0.851, P<0.001) and test sets (AUC: 0.802, 95% CI: 0.724-0.879, P<0.001). The calibration curve analysis indicated good agreement between the predicted probabilities of ultrasomics and actual lymph node metastasis status.
ConclusionOur study highlights the potential of a machine learning-based ultrasomics model in predicting lymph node metastasis in GC patients, offering implications for personalized therapy approaches.
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Aberrant Intra- and Inter-Network Connectivity in Idiopathic Sudden Sensorineural Hearing Loss with Tinnitus
Authors: Yawen Zhang, Chengyan Feng, Jinjia Qian, Genxu Zhu, Xiaomin Xu, Jin-Jing Xu, Yu-Chen Chen and Zigang CheBackgroundIdiopathic Sudden Sensorineural Hearing Loss (ISSNHL) is related to alterations in brain cortical and subcortical structures, and changes in brain functional activities involving multiple networks, which is often accompanied by tinnitus. There have been many in-depth research studies conducted concerning ISSNHL. Despite this, the neurophysiological mechanisms of ISSNHL with tinnitus are still under exploration.
ObjectiveThe study aimed to investigate the neural mechanism in ISSNHL patients with tinnitus based on the alterations in intra- and inter-network Functional Connectivity (FC) of multiple networks.
MethodsThirty ISSNHL subjects and 37 healthy subjects underwent resting-state functional Magnetic Resonance Imaging (rs-fMRI). Independent Component Analysis (ICA) was used to identify 8 Resting-state Networks (RSNs). Furthermore, the study used a two-sample t-test to calculate the intra-network FC differences, while calculating Functional Network Connectivity (FNC) to detect the inter-network FC differences.
ResultsBy using the ICA approach, tinnitus patients with ISSNHL were found to have FC changes in the following RSNs: CN, VN, DMN, ECN, SMN, and AUN. In addition, the interconnections of VN-SMN, VN-ECN, and ECN-DAN were weakened.
ConclusionThe present study has demonstrated changes in FC within and between networks in ISSNHL with tinnitus, providing ideas for further study on the neuropathological mechanism of the disease.
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The Value of Radiomics Features Based on HRCT in Predicting whether the Lung Sub-Centimeter Pure Ground Glass Nodule is Benign or Malignant
Authors: Xiaoxia Ping, Yuanqing Liu, Rong Hong, Su Hu and Chunhong HuObjectiveIn this study, a radiomics model was created based on High-Resolution Computed Tomography (HRCT) images to noninvasively predict whether the sub-centimeter pure Ground Glass Nodule (pGGN) is benign or malignant.
MethodsA total of 235 patients (251 sub-centimeter pGGNs) who underwent preoperative HRCT scans and had postoperative pathology results were retrospectively evaluated. The nodules were randomized in a 7:3 ratio to the training (n=175) and the validation cohort (n=76). The volume of interest was delineated in the thin-slice lung window, from which 1316 radiomics features were extracted. The Least Absolute Shrinkage and Selection Operator (LASSO) was used to select the radiomics features. Univariate and multivariable logistic regression were used to evaluate the independent risk variables. The performance was assessed by obtaining Receiver Operating Characteristic (ROC) curves for the clinical, radiomics, and combined models, and then the Decision Curve Analysis (DCA) assessed the clinical applicability of each model.
ResultsSex, volume, shape, and intensity mean were chosen by univariate analysis to establish the clinical model. Two radiomics features were retained by LASSO regression to build the radiomics model. In the training cohort, the Area Under the Curve (AUC) of the radiomics (AUC=0.844) and combined model (AUC=0.871) was higher than the clinical model (AUC=0.773). In evaluating whether or not the sub-centimeter pGGN is benign, the DCA demonstrated that the radiomics and combined model had a greater overall net benefit than the clinical model.
ConclusionThe radiomics model may be useful in predicting the benign and malignant sub-centimeter pGGN before surgery.
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Diagnostic Value of X-Map Images Reconstructed by Plain Dual-Energy Computed Tomography Scans in Acute Ischemic Stroke
Authors: Yongsheng Cui, Weiyi Gong, Shuhua Duan, Guanming Ji, Yuqi Wang, Xuehui Wu and Hongfeng ShiObjectiveThis study aimed to evaluate the diagnostic value of X-Map reconstruction based on Dual-Energy Computed Tomography (DECT) in acute ischemic stroke (AIS).
MethodsSixty-six cases of suspected AIS patients hospitalized from November, 2021 to April, 2022 were retrospectively selected. DECT, Computed Tomography Perfusion imaging (CTP), Computed Tomography Angiography (CTA), and MRI were all performed within 24 hours after symptom onset. As the gold standard for diagnosing AIS, a total of 53 patients were diagnosed with AIS based on the diffusion-weighted imaging positive results in MRI. The Chi-square test was used to evaluate the diagnostic efficacy of AIS among X-Map, CTP, and CTA.
ResultsIn the 53 patients with confirmed ASI, a total of 72 lesions were detected, including in the frontal lobes (n=33), parietal lobes (n=7), temporal lobes (n=12), basal ganglia regions (n=12), thalamus (n=3), and pons (n=5). The case detection rate of X-Map for AIS was similar to that of CTP (p=0.151) but was significantly higher than that of CTA (p<0.001). In terms of diagnostic efficacy, among the total 66 patients enrolled, X-Map achieved a higher diagnostic sensitivity (85%) than CTP and CTA. However, CTP achieved the best diagnostic specificity (84.6%) and diagnostic accuracy (77.4%) among the diagnostic tools used.
ConclusionX-Map provides a better or equal clinical value for the diagnosis of AIS as compared to CTA and CTP, respectively, highlighting its potential in clinical applications.
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Prediction Model and Nomogram of Early Recurrence of Hepatocellular Carcinoma after Ultrasound-guided Microwave Ablation
Authors: Xinyao Wang, Dongyue Gu, Haiying Qin, Xiao Lu, Jingxi Hu, Huan Zhang, Xiaoqi Wan and Guangbin HeBackground:Ultrasound-guided microwave ablation (MWA) is recommended as a first-line treatment for early liver cancer due to its minimally invasive, efficient, and cost-effective nature. It utilizes microwave radiation to heat and destroy tumor cells as a local thermal therapy and offers the benefits of being minimally invasive, repeatable, and applicable to tumors of various sizes and locations. However, despite the efficacy of MWA, early recurrence after treatment remains a challenge, particularly when it occurs within a year and has a significant impact on the prognosis of the patient.
Objective:This study aimed to identify the risk factors for early recurrence after MWA in patients with hepatocellular carcinoma (HCC) and establish a predictive model.
Methods:A total of 119 patients with hepatocellular carcinoma (HCC) treated in the Department of Ultrasound at the First Affiliated Hospital of the Air Force Medical University from January, 2020 to April, 2022 were included in this study. Patients were categorized into the early recurrence group and the non-early recurrence group based on whether recurrence occurred within 1 year. We conducted univariate analysis on 29 variables. A predictive model was developed using multiple-factor logistic regression analysis, and a risk column graph was created.
Results:A total of 28 patients were included in the early recurrence group, with an early recurrence rate of 23%. Tumor size ≥ 3cm, multiple tumors, AST > 35 U/L, low pathological differentiation, CD34 positive, Ki67 level, quantitative parameters mean transit time (mTT), and rise time (RT) were confirmed as risk factors affecting early recurrence after ablation (P < 0.05). Furthermore, the model constructed based on these 5 predictive factors, including tumor size, tumor number, pathological differentiation, CD34, and quantitative analysis parameter mTT, demonstrated good predictive ability, with an AUC of 0.93 in the training set and 0.86 in the validation set.
Conclusion:Our research indicates that the risk column graph can be utilized to predict the risk of early postoperative recurrence in patients after MWA. This contributes to guiding personalized clinical treatment decisions and provides important references for improving the prognosis of patients.
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Patient Data Hiding and Transmitting during COVID-19 for Telemedicine Application using Image Steganography
Authors: B Lakshmi Sirisha, Shaik Fayaz Ahamed and VBKL ArunaAim of the StudyPost COVID-19, everyone needs to be aware of health. The condition of the human body is judged based on various health reports like X-ray, CT scan and MRI scan. Due to misplacement or loss of medical reports, there lies a high chance of improper diagnosis.
MethodsIn order to avoid improper diagnosis, a novel data-hiding technique is proposed in this work. In the proposed method, the patient’s health records are hidden using polynomial theory in the patient photograph. This is used by doctors in telemedicine for better treatment at the right time. Image steganography is useful for hiding secret images and also for generating secret keys. This enables only the authorized people (patient and corresponding doctor) to access the reports using secret keys.
ResultsFour secret images (medical reports of the patient) are successfully embedded onto a single cover image (patient photo) with good quality. After embedding, the stego images look like cover images so that unauthorized persons will not be able to access the data, and hence, safe transmission is being carried out.
ConclusionA patient's medical report plays an important role in proper medical treatment. Particularly in telemedicine, the safe transmission of patient reports without any loss or damage is necessary. The proposed method embeds reports of a patient in his/her photo and transmits them to the destination safely with a quality of 45.5 dB. This hiding method is helpful to avoid cyber crimes, illegal transactions, malpractices etc.
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The Combination of Gd-EOB-DTPA Enhanced T1 Mapping with Apparent Diffusion Coefficient could Improve the Diagnostic Efficacy of Hepatocellular Carcinoma Grading
Authors: Hui He, Xiaotian Li, Jing Liu, Qiuyun Tong, Min Ling, Zisan Zeng and Zhipeng ZhouBackground:Accurately predicting the hepatocellular carcinoma (HCC) grade may facilitate the rational selection of treatment strategies. The diagnostic efficacy of the combination of Gadolinium ethoxybenzy diethylenetriamine pentaacetic (Gd-EOB-DTPA) enhancement T1 mapping and apparent diffusion coefficient (ADC) values in predicting HCC grade needs further validation.
Objectives:This study aimed to assess the capacity of Gd-EOB-DTPA-enhanced T1 mapping and ADC values, both individually and in combination, to discriminate between different grades of HCC.
Materials and Methods:From July 2017 to February 2020, 96 patients (male, 83; mean age, 53.67 years; age range, 29-71 years) clinically diagnosed with HCC were included in the present study. All patients underwent Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI, including T1 mapping sequence) before surgery or biopsy. All the patients were categorized into 3 groups according to the pathological results (including 24 cases of well-differentiated HCCs, 59 cases of moderately differentiated HCCs, 13 cases of and poorly differentiated HCCs). The mean Gd-EOB-DTPA enhanced T1 values (∆T1=[(T1pre-T1post)/T1pre]×100%) and ADC values between different grading groups of HCC were calculated and compared. The area under the characteristics curve (AUC), the diagnostic threshold, sensitivity, and specificity of ΔT1 and ADC for differential diagnosis were analyzed.
Results:Mean ∆T1 was 58% for well-differentiated HCCs, 50% for moderately-differentiated HCCs, and 43% for poorly-differentiated HCCs. ∆T1 showed statistical differences between the groups (P<0.001). The mean ADC values of the 3 groups were 1.11×10−3 mm2/s, 0.91×10−3 mm2/s, and 0.80×10−3mm2/s, respectively. ADC showed statistical differences between the groups (P<0.001). In discriminating well- differentiated group from the moderately differentiated group, the AUC of ∆T1 was 0.751 (95% CI: 0.642, 0.859), the AUC of ADC was 0.782 (95% CI: 0.671, 0.894), the AUC of combined model was 0.811 (95% CI: 0.709, 0.914). In discriminating the poorly differentiated group from the moderately differentiated group, the AUC of ∆T1 was 0.768 (95% CI: 0.634, 0.902), the AUC of ADC was 0.754 (95% CI: 0.603, 0.904), and the AUC of the combined model was 0.841 (95% CI: 0.729, 0.953).
Conclusion:Gd-EOB-DTPA enhanced T1 mapping, and ADC values have complementary effects on the sensitivity and specificity for identifying different HCC grades. A combined model of Gd-EOB-DTPA-enhanced MRI T1 mapping and ADC values could improve diagnostic performance for predicting HCC grades.
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Evaluation of Neoadjuvant Chemoradiotherapy Response in Rectal Cancer Using MR Images and Deep Learning Neural Networks
IntroductionThe aim of the study was to develop deep-learning neural networks to guide treatment decisions and for the accurate evaluation of tumor response to neoadjuvant chemoradiotherapy (nCRT) in rectal cancer using magnetic resonance (MR) images.
MethodsFifty-nine tumors with stage 2 or 3 rectal cancer that received nCRT were retrospectively evaluated. Pathological tumor regression grading was carried out using the Dworak (Dw-TRG) guidelines and served as the ground truth for response predictions. Imaging-based tumor regression grading was performed according to the MERCURY group guidelines from pre-treatment and post-treatment para-axial T2-weighted MR images (MR-TRG). Tumor signal intensity signatures were extracted by segmenting the tumors volumetrically on the images. Normalized histograms of the signatures were used as input to a deep neural network (DNN) housing long short-term memory (LSTM) units. The output of the network was the tumor regression grading prediction, DNN-TRG.
ResultsIn predicting complete or good response, DNN-TRG demonstrated modest agreement with Dw-TRG (Cohen’s kappa= 0.79) and achieved 84.6% sensitivity, 93.9% specificity, and 89.8% accuracy. MR-TRG revealed 46.2% sensitivity, 100% specificity, and 76.3% accuracy. In predicting a complete response, DNN-TRG showed slight agreement with Dw-TRG (Cohen’s kappa= 0.75) with 71.4% sensitivity, 97.8% specificity, and 91.5% accuracy. MR-TRG provided 42.9% sensitivity, 100% specificity, and 86.4% accuracy. DNN-TRG benefited from higher sensitivity but lower specificity, leading to higher accuracy than MR-TRG in predicting tumor response.
ConclusionThe use of deep LSTM neural networks is a promising approach for evaluating the tumor response to nCRT in rectal cancer.
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Risk Prediction of Type 2 Diabetes Mellitus by MRI-based Pancreatic Morphology and Clinical Characteristics: A Cross-sectional Study
Authors: Yunjing Yan, Tengyue Wu, Zhengkuan Huang, Xueliang Song, Xiaohua Huang and Nian LiuObjectives:This study aimed to investigate the pancreatic morphology and clinical characteristics to predict risk factors of type 2 diabetes mellitus (T2DM) based on magnetic resonance imaging.
Methods:A total of 89 patients (T2DM group) and 68 healthy controls (HC group) were included. The T2DM group was divided into a long-term T2DM group and a short-term T2DM group according to whether the illness duration was more than 5 years. The clinical characteristics were collected, including sex, age, fasting plasma glucose, glycosylated hemoglobin, and lipoproteins. The pancreatic morphological characteristics, including the diameters of the pancreatic head, neck, body, and tail, the angle of the pancreaticobiliary junction (APJ), and the types of pancreaticobiliary junction were measured. The risk prediction model was established by logistic regression analysis.
Results:In the long-term T2DM group, the pancreatic diameters were smaller than the other two groups. In the short-term T2DM group, the diameters of the pancreatic tail and body were smaller than the HC group. The APJ, very low-density lipoprotein, and triglyceride levels in the two T2DM groups were greater than the HC group, and the APJ of the short-term T2DM group was smaller than the long-term T2DM group. Pancreatic diameters showed a negative correlation with illness duration. Logistic regression analysis revealed pancreatic body diameter was a protective factor, and APJ was a risk factor for T2DM. Prediction model accuracy was 90.20%.
Conclusions:The morphology of the pancreas is helpful to predict the risk of the onset of T2DM. The risk of onset of T2DM increases with smaller pancreatic body diameter and higher APJ.
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Analysis of Ileal Atresia from Prenatal Ultrasound to Postoperative Follow-up: Two Case Reports
Authors: Zimeng Lv, Hongyi Qu, Jingyuan Hu, Yue Dong and Wei LiuBackgroundCongenital ileal atresia is a rare neonatal disease, the most common type of intestinal malformation in newborns, and one of the most common causes of congenital intestinal obstruction. It can cause various digestive system symptoms, including abdominal distension, vomiting, abnormal bowel movements, etc. In severe cases, it can be life-threatening. A prenatal ultrasound examination can assist clinical diagnosis of congenital ileal atresia, and those with a clear prenatal diagnosis should undergo surgical treatment after birth.
Case PresentationWe have, herein, reported two cases of congenital ileal atresia, both of which showed fetal intestinal dilation (>7mm) and excessive amniotic fluid on prenatal ultrasound. Both newborns underwent surgical treatment after delivery and were confirmed to have congenital ileal atresia during surgery. Due to the different prenatal ultrasound manifestations of the two patients, they were divided into two different subtypes based on intraoperative manifestations. We observed significant differences in the prognosis of the two patients after surgery.
ConclusionAccurately locating and classifying ileal atresia using prenatal ultrasound is challenging; however, it plays an effective role in disease progression, gestational assessment, and prognosis. Accurately identifying intestinal diseases and/or the location of lesion sites through direct and indirect ultrasound findings in the fetal abdominal cavity is an important research direction for prenatal ultrasound.
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Feasibility of Amide Proton Transfer-weighted Imaging at 3T for Renal Masses: A Preliminary Study
Authors: Yun Xu, Qingxuan Wan, Xihui Ren, Yutao Jiang, Jing Yao, Peng WU, Aijun Shen and Peijun WangBackgroundTo investigate the optimal B1,rms value of renal amide proton transfer-weighted (APTw) images and the reproducibility of this value, and to explore the utility of APT imaging of renal masses and kidney tissues.
MethodsAPTw images with different B1,rms values were repeatedly recorded in 15 healthy volunteers to determine the optimal value. Two 4-point Likert scales (poor [1] to excellent [4]) were used to evaluate contour clarity and artifacts in masses and normal tissues. The APTw values of masses and normal tissues were then compared in evaluable images (contour clarity score > 1, artifacts score > 1). The APTw of malignant masses, normal tissues, and benign masses were calculated and compared with the Mann-Whitney U test.
ResultsThe optimal scanning parameter of B1,rms was 2 μT, and the APTw images had good agreement in the volunteers. Our study of APTw imaging examined 70 renal masses (13 benign, 57 malignant) and 49 normal kidneys (including those from 15 healthy volunteers). The mean APTw value for renal malignant masses (2.28(1.55)) was different from that for benign masses (0.91(1.30)) (P<0.001), renal cortex (1.30 (1.25)) (P<0.001), renal medulla (1.64 (1.33)) (P<0.05), and renal pelvis (5.49 (2.65)) (P<0.001).
ConclusionThese preliminary data demonstrate that APTw imaging of the kidneys has potential use as an imaging biomarker for the differentiation of normal tissues, malignant masses, and benign masses.
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The Potential of Radiolabeled Bisphosphonates in SPECT and PET for Bone Imaging
Skeletal-related events due to bone metastases can be prevented by early diagnosis using radiological or nuclear imaging techniques. Nuclear medicine techniques such as Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET) have been used for diagnostic imaging of bone for decades. Although it is widely recognized that conventional diagnostic imaging techniques such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) have high sensitivity, low cost and wide availability, the specificity of both techniques is rather low compared to nuclear medicine techniques. Nuclear medicine techniques, on the other hand, have improved specificity when introduced as a hybrid imaging modality, as they can combine physiological and anatomical information. Two main radiopharmaceuticals are used in nuclear medicine: [99mTc]-methyl diphosphonate ([99mTc]Tc-MDP) from the generator and [18F]sodium fluoride ([18F]NaF) from the cyclotron. The former is used in SPECT imaging, while the latter is used in PET imaging. However, recent studies show that the role of radiolabeled bisphosphonates with gallium-68 (68Ga) and fluorine-18 (18F) may have a potential role in the future. This review, therefore, presents and discusses the brief method for producing current and future potential radiopharmaceuticals for bone metastases.
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Diagnostic Value of 3.0 T Magnetic Resonance Imaging in Active Crohn's Disease
Authors: Li-Li Fu, Xiao-Zhao Zhuang, Chang-Qing Li and Chui-Wen ChenBackgroundMagnetic resonance enteroclysis (MRE) has been widely applied to diagnose Crohn’s disease (CD). Magnetic resonance (MR) at 3.0 T improves signal-to-noise ratio (SNR), shortens image acquisition time, and shows more advantages.
ObjectiveThis study aimed to retrospectively analyze the diagnostic value of 3.0 T MR imaging for active CD.
Methods48 CD patients hospitalized in our hospital from January 2021 to December 2022 were selected as the study subjects. These 48 CD patients underwent both double-balloon enteroscopy and 3.0 T MRE. All patients' arterial phase signal, venous phase signal, bowel wall, and bowel lumen of MRE were observed to identify whether they suffered from active CD. Based on the results of enteroscopy, the number of true positives, true negatives, false negatives, and false positives diagnosed by MRE were screened; next, the diagnostic accuracy, sensitivity, and specificity of MRE in assessing active CD were calculated.
ResultsOf the 48 patients, 39 were diagnosed with small bowel CD by MRE, which was not significantly different from the results of enteroscopy (P>0.05). According to MRE diagnostic results, the arterial phase predominantly presented high signal intensity, and the venous phase mainly presented low signal intensity or isointensity. Small bowel CD lesions were primarily characterized by bowel wall thickening, rare pneumatosis enhancement of the bowel wall, bowel lumen pneumatosis or dilatation, and rare strictures. Besides, MRE presented an accuracy of 93.75%, sensitivity of 97.37%, and specificity of 80.00% in diagnosing CD.
Conclusion3.0 T MR imaging has diagnostic value for active CD and shows certain clinical application value.
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Intracardiac and Pericardial Hydatid Cyst Concurrent with Multi-Organ Involvement: A Case Report
Authors: Mobina Ameri, Elahe Aleebrahim-Dehkordi, Faezeh Soveyzi and Masoud Mahdavi RashedIntroductionHydatidosis, a distinctive parasitic ailment, exhibits a broad range of imaging characteristics influenced by the growth stage, resultant complications, and tissue involvement. Its occurrence throughout the human anatomy underscores its ubiquitous propensity. Despite its relatively infrequent manifestation as diffuse hydatosis, the disease assumes particular significance in rural regions. Given its detrimental complications and resemblance to other cystic conditions, vigilance towards the potential presence of this ailment becomes imperative.
Case PresentationIn 2022, a 12-year-old female patient residing in a village sought medical assistance for left flank pain. During the evaluation, an incidental discovery of a pancreatic cyst through sonography prompted further investigation. Subsequent abdominopelvic computed tomography (CT) scans identified multiple lesions consistent with hydatid cysts in various anatomical locations, including the pancreas, right atrium, ventricle of the heart, pericardium, and lung. Confirmation of the hydatid cysts was obtained through pathology examination and consideration of the patient's medical history, which included a previously diagnosed brain hydatid cyst. Treatment with albendazole was initiated, and the patient underwent cardiac surgical intervention. Unfortunately, the condition of the patient deteriorated, leading to septic shock and subsequent mortality.
ConclusionIn areas with a high prevalence of hydatid cysts, the presence of diverse lesions on radiologic assessments, despite negative serologic tests, should raise suspicion for this condition. Furthermore, understanding the importance of timely detection and intervention is crucial, as it greatly impacts patient prognosis,. In the advanced stages of the disease, particularly when cardiac involvement occurs, surgical excision of the cysts remains the sole therapeutic approach, albeit accompanied by certain complications. Through the utilization of various imaging modalities and early recognition and treatment, the need for more complex interventions can be minimized.
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Improving Breast Cancer Detection with Convolutional Neural Networks and Modified ResNet Architecture
Authors: Javad Nouri Pour, Mohammad Ali Pourmina and Mohammad Naser MoghaddasiBackgroundThe pathogenesis of breast cancer is characterized by dysregulated cell proliferation, leading to the formation of a neoplastic mass. Conventional methodologies for analyzing carcinomatous distal areas within whole-slide images (WSIs) tissue regions may lack comprehensive insights.
PurposeThis study aims to introduce an innovative methodology based on convolutional neural networks (CNN), specifically employing a CNN Modified ResNet architecture for breast cancer detection. The research seeks to address the limitations of existing approaches and provide a robust solution for the comprehensive analysis of tissue regions.
MethodsThe dataset utilized in this study comprises approximately 275,000 RGB image patches, each standardized at 50x50 pixels. The CNN Modified ResNet architecture is implemented, and a comparative evaluation against diverse architectures is conducted. Rigorous validation tests employing established performance metrics are carried out to assess the proposed methodology.
ResultsThe proposed architecture achieves a notable 89% accuracy in breast cancer detection, surpassing alternative methods by 2%. The results signify the efficacy and superiority of the CNN Modified ResNet model in analyzing carcinomatous distal areas within WSIs tissue regions.
ConclusionIn conclusion, this study demonstrates the potential of the CNN Modified ResNet architecture as an effective tool for breast cancer detection. The enhanced accuracy and comprehensive analysis capabilities make it a promising approach for advancing the understanding of neoplastic masses in WSIs tissue regions. Further research and validation could solidify its role in clinical applications and diagnostic procedures.
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Imaging Diagnosis of Retroperitoneal Müllerian Duct-derived Cyst Complicated by Diaphragmatic Hernia: A Case Report
Authors: Fuqiang Tang and Jing ZhangBackgroundThis case report describes a case of Müllerian duct cyst that occurred in a male retroperitoneum. The cyst lesion is rare and complicated with diaphragmatic hernia. Müllerian duct-derived cyst is a rare developmental disorder that is more common in male pelvic tissues and rare in the retroperitoneum. We investigated the important role of computerized tomography (CT) and magnetic resonance imaging (MRI) in preoperative diagnosis and disease prediction of this condition.
Case PresentationA 25-year-old male was found to have an abnormal occupying lesion in the left diaphragm in imaging examinations, usually healthy with no obvious clinical symptoms. X-ray examination showed a circular, high-density shadow near the left diaphragm. CT scan showed a soft tissue density shadow resembling a tumor in the left adrenal area, irregularly protruding into the chest cavity, with uneven density. MRI examination showed an irregular elongated T1 and T2 signal shadow in the left adrenal area. T2 fat suppression showed high signal intensity with unrestricted diffusion. Robotic-assisted laparoscopic surgery showed left retroperitoneal tumor resection. The patient recovered well postoperatively and had no recurrence after discharge follow-up.
ConclusionThe preclinical symptoms of retroperitoneal Müllerian cysts complicated by diaphragmatic hernia in young men are difficult to distinguish, and it is difficult to diagnose other similar cysts with imaging. The method of combined CT and MRI diagnosis guides the endoscopic robot-assisted minimally invasive surgery for excision of cysts to achieve accurate diagnosis and treatment of such diseases.
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Hypoperfusion of Amygdala in Chronic Migraine: An Exploratory Quantitative Perfusion Imaging using 3D Pseudo-Continuous Arterial Spin Labeling
Authors: Yujiao Jiang, Xin Li, Shuqiang Zhao, Mengqi Liu and Zhiye ChenBackground:Although the amygdala has structural and functional abnormalities in Chronic Migraine (CM), less is known about the altered perfusion of the amygdala in CM.
Objective:The current study aimed to assess amygdala perfusion in CM using a contrast agent-free and quantitative approach.
Methods:15 Normal Controls (NC) and 13 patients with CM during the migraine interval were assessed for brain structure and subjected to 3D Pseudo-Continuous Arterial Spin Labeling (3D-PCASL) MR imaging. The Cerebral Blood Flow (CBF) value of the amygdala was automatically extracted based on the individual amygdala mask for all participants. The independent sample t-test, Receiver Operating Characteristic (ROC) curve, and correlation analysis were used to evaluate the perfusion changes in CM.
Results:Bilateral amygdala cerebral perfusion was lower in CM (left amygdala, 42.21±4.49 ml/100mg/min; right amygdala, 42.38±4.41 ml/100mg/min) than in NC (left amygdala, 48.31±6.92 ml/100mg/min; right amygdala, 47.88±6.53 ml/100mg/min) (left, p = 0.01; right, p = 0.02). There was no significant correlation between the perfusion of bilateral amygdalas and the clinical variables. Also, there was no significant difference in the volume of bilateral amygdalas between the two groups. The Area Under the Curve (AUC) of the CBF values of the left and right amygdala was 0.78 (95%CI: 0.58-0.91) and 0.75 (95%CI: 0.55-0.89), respectively. The cut-off value was 44.24 ml/100mg/min (left amygdala, with sensitivity 76.90% and specificity 78.70%) and 46.75 ml/100mg/min (right amygdala, with sensitivity 92.3% and specificity 58.80%), respectively.
Conclusion:CM presented bilateral hypoperfusion in the amygdala, offering potential diagnostic value in distinguishing CM from NC. The 3D-PCASL could be regarded as a simple and efficient neuroimaging tool to assess the perfusion status in CM patients.
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Bibliometric Review of Optimization and Image Processing of Positron Emission Tomography (PET) Imaging System between 1981-2022
BackgroundPositron Emission Tomography (PET) scan stands as a valuable diagnostic tool in nuclear medicine, enabling the observation of metabolic and physiological changes at a molecular level. However, PET scans have a number of drawbacks, such as poor spatial resolution, noisy images, scattered radiation, artifacts, and radiation exposure. These challenges demonstrate the need for optimization in image processing techniques.
ObjectivesOur objective is to identify the evolving trends and impacts of publication in this field, as well as the most productive and influential countries, institutions, authors, themes, and articles.
MethodsA bibliometric study was conducted using a comprehensive query string such as “positron emission tomography” AND “image processing” AND optimization to retrieve 1,783 publications from 1981 to 2022 found in the Scopus database related to this field of study.
ResultsThe findings revealed that the most influential country, institution, and authors are from the USA, and the most prevalent theme is TOF PET image reconstruction.
ConclusionThe increasing trend in publication in the field of optimization of image processing in PET scans would address the challenges in PET scan by reducing radiation exposure, faster scanning speed, as well as enhancing lesion identification.
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T2 Relaxation Time in Extraocular Muscles of Patients with Mild Thyroid-Associated Ophthalmopathy: Comparing T2 Mapping With and Without Fat Suppression Using Different Measurement Methods
Authors: Defu Li, Xuejun Guo, Jianguo Zeng, Huijie Feng, Tingting Zhu and Hongbing LiObjectiveThis study aimed to compare the parametric value of T2 with and without fat suppression (FS) on T2 mapping for the evaluation of extraocular muscles (EOMs) in mild thyroid-associated ophthalmopathy (TAO).
MethodsWe prospectively recruited 44 consecutive patients with mild TAO seen between May 2020 and October 2022 and 26 healthy controls with no history of eye- or thyroid-related or other autoimmune diseases. Patients with mild TAO were subdivided into active and inactive groups based on their clinical activity scores. The T2 of each EOM was measured over a large and small area of interest on T2-mapping images with and without FS. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of T2 for detecting TAO activity.
ResultsThe T2 was significantly and heterogeneously higher in the active group than in the inactive and control groups (P < 0.05). FS-T2-mapping images had better signal display within and at the edges of the EOMs than those without FS. It was possible to observe high-signal aggregation visible in the periphery of some EOMs, and the central part showed relatively low signals. The maximum T2 measured in small or large areas with and without FS had good diagnostic efficacy for TAO activity, with that of no-FS being better (the area under the ROC curve of the maximum T2 measured in a small area and a large area without FS was 1.0 and 1.0 and P values of < 0.001 and < 0.001, respectively).
ConclusionMaximal T2 with or without FS can facilitate the early clinical detection of mild TAO activity. The maximum T2 in a small area can facilitate active staging of patients with mild TAO.
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The Value of Computer Vision in Identifying the Bone of Dialysis Patients
Authors: Wei Zhang, Dong Sun, Xiaoli Zhang and Gang WuBackgroundIn the end stage of kidney disease, abnormal levels of blood calcium, phosphorus, and parathyroid hormone lead to bone metabolism disorders, manifesting as osteoporosis or fibrocystic osteoarthritis. X-ray, CT, and MR are useful for detecting bone lesions in dialysis patients, but currently, computer vision has not yet been used for this purpose.
MethodsResNet is a powerful deep CNN model, which has not yet been used to distinguish between the bones of dialysis patients and healthy people. Therefore, this study aimed to investigate the ability of the Resnet50 model to identify the bone of dialysis patients from normal bone.
ResultsCT images of 200 cases (100 dialysis patients and 100 healthy people aged 31-72 years with male:female ratio of 51:49) were randomly divided into the training and testing groups at the ratio of 8:2. The module of ‘torch’ was used to train the model of Resnet50 for the current task of image classification. In the test cohort, the accuracy, sensitivity, and specificity with hyper-parameter=0 were 60%, 65%, and 55%, respectively. When the hyper-parameter was 0.6 or 0.7 versus 0, the accuracy was significantly higher (P<0.05). When the hyper-parameter was another number, the accuracy was not significantly different from that with no hyper-parameter (P>0.05).
ConclusionThis study has indicated computer vision to be suitable for identifying bone changes caused by dialysis; a hyper-parameter has been found necessary for improving model accuracy. The ResNet50 model with hyper-parameter = 0.7 has exhibited 90% sensitivity in identifying the bone of dialysis patients.
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Impairment of Left Ventricular Function in the Depressed Chinese Miniature Swine Model by Cardiovascular Magnetic Resonance Feature-Tracking: A Preliminary Study
Authors: Huihui Kong, Lijun Zhang and Yi HePurposeIndividuals with depression have an increased risk of cardiovascular disease, and more often have a poor prognosis with cardiovascular disease. This study aimed to investigate the impact of depression on Left Ventricular (LV) alterations using Cardiovascular Magnetic Resonance Feature-tracking (CMR-FT).
MethodsSeven anesthetized, healthy Chinese miniature swine were included in the study. Basic data, including CMR scans at baseline and after 14 days of depression modeling, were collected. Behavioral tests, including the Open-field Test (OFT), Sucrose Preference Test (SPT), and measurements of the time taken to consume a specific amount of food and sugar, were conducted to assess the success of the depression models. CMR cine images were acquired and CVI software was employed to analyze Global Longitudinal Strain (GLS), Global Circumferential Strain (GCS), and Global Radial Strain (GRS). Late Gadolinium Enhancement (LGE) imaging was used to detect myocardial infarction and/or scar.
ResultsThe outcomes demonstrated successful depression modeling, indicated by reduced scores in the OFT and SPT, as well as an extended time to intake food and sugar compared to baseline. However, no significant differences were observed in LV End-diastolic Volume (LVEDV), LV End-systolic Volume (LVESV), LV Ejection Fraction (LVEF), LV End-diastolic Myocardial Mass (LVMASSED), and Cardiac Output (CO) before and after modeling. Regarding LV global strain parameters, there was a downward trend in GRS (25.35% ± 6.9% vs. 22.86% ± 6.4%, P=0.021), GCS (-16.71% ± 4.2% vs. -14.78% ± 2.3%, P=0.043), and GLS (-17.66% ± 2.9% vs. -14.53% ± 2.5%, P=0.056), respectively, after modeling. GRS and GCS were significantly reduced after modeling compared to baseline.
ConclusionThe study suggests that depression may contribute to early LV systolic dysfunction, particularly affecting LV GCS and GRS.
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Comparison of Doppler Imaging and Microvascular Imaging in Cervical Lymph Node Blood Flow Analysis
Authors: Zhanghui Yang, Jinhua Cai, Yu Wang, Lilu Shu, Wenjun Liu and Zhiwei WangCervical lymph node metastasis is an important determinant of cancer stage and the selection of an appropriate treatment plan for patients with head and neck cancer. Therefore, metastatic cervical lymph nodes should be effectively differentiated from lymphoma, tuberculous lymphadenitis, and other benign lymphadenopathies. The aim of this work is to describe the performance of Doppler ultrasound and superb microvascular imaging (SMI) in evaluating blood flow information of cervical lymph nodes. In addition, the features of flow imaging in metastatic lymph nodes, lymphoma, and tuberculous lymphadenitis were described. Compared with Doppler ultrasound, SMI, the latest blood flow imaging technology, could detect more blood flow signals because the sensitivity, specificity, and accuracy of SMI in the diagnosis of cervical lymph node disease were higher. This article summarizes the value of Doppler ultrasound and SMI in evaluating cervical lymph node diseases and focuses on the diagnostic performance of SMI.
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A Case Report of Invasive Lobular Carcinoma of Breast with Multiple Gastrointestinal and Cutaneous Metastases
Authors: Yuhan Bao, Jingbo Wang and Jie XueBackgroundThe metastasis of primary breast invasive lobular carcinoma to the gastrointestinal tract and skin is a rare phenomenon, with the simultaneous occurrence of both transfers being more uncommon.
Case PresentationThis article reports a case of a patient with hormone receptor-positive, HER2-negative breast invasive lobular carcinoma with gastrointestinal tract and skin metastases. The patient was assessed by a second-look ultrasound and diagnosed by subsequent ultrasound-guided needle biopsy. Following endocrine therapy, a favorable effect was observed, with significant regression of the primary breast lesion, cutaneous metastases, and gastrointestinal metastases.
ConclusionPatients with breast invasive lobular carcinoma should be alert to the possibility of breast cancer metastasis, even if there are no obvious symptoms or signs, when they encounter rapidly progressive cutaneous nodules or plaques, or if they possess gastrointestinal abnormalities. For patients with negative breast ultrasonography for the first time, after combining mammography, Contrast-enhanced Spectral Mammography (CESM) or Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) examinations, if breast cancer is highly suspected, second-look ultrasound is particularly crucial at this juncture, which is the key prerequisite for breast needle biopsy and obtaining the gold standard of pathology.
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Role of Carotid Ultrasonography Combined with Monocyte/HDL Ratio in Internal Carotid Artery Stenosis
Authors: Min-qiang Bao, Yi-nong Chen, Ji-wei Jin, Dong-dong Gui, Jie Wang, Shuang-shuang Chen, Xiao-ning Sheng, Zhang-long Cheng and Yu WangBackground:Carotid duplex ultrasonography (DUS) is the primary screening tool for carotid artery stenosis, but has low reliability. MHR, which is the ratio of monocytes to high-density lipoprotein cholesterol (HDL-C), can be a marker for the degree and distribution of extracranial and intracranial atherosclerotic stenosis.
Objective:We determined the diagnostic value of DUS+MHR for internal carotid artery (ICA) stenosis.
Methods:We divided 273 hospitalized patients into non-stenosis (<50%) and ICA stenosis (≥50%) groups based on Digital Subtraction Angiography (DSA). We determined the peak systolic velocity (PSV) in the ICA on DUS, calculated the MHR, and investigated their relationship with ICA stenosis.
Results:On DSA, 34.1% (93/273) patients had moderate-to-severe ICA stenosis. DUS and DSA showed low concordance for detecting ICA stenosis (kappa = 0.390). With increasing age, the incidence of moderate-to-severe ICA stenosis increased. PSV, monocyte count, and MHR were significantly greater in the stenosis group than in the non-stenosis group (P < 0.001), while the HDL-C level was significantly lower (P = 0.001). PSV (OR: 1.020, 95% CI: 1.011–1.029, P < 0.001) and MHR (OR: 5.662, 95% CI: 1.945–16.482, P = 0.002) were independent risk factors for ICA stenosis. The area under the receiver operating characteristic curve of PSV+MHR (0.819) was significantly higher than that of PSV or MHR alone (77.42% sensitivity, P = 0.0207; 73.89% specificity, P = 0.0032).
Conclusion:The combination of ICA PSV on DUS and MHR is better than PSV alone at identifying ICA stenosis and is well-suited to screen high-risk patients.
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Using Apparent Diffusion Coefficient (ADC) of Endometrial Cancer MRI to Determine P53 Molecular Subtypes
Authors: Feiran Zhang, Tianping Wang, Yan Ning, Shengyong Li, Xiaojun Chen, Guofu Zhang and He ZhangBackground:Endometrial Cancer (EC) is a highly heterogeneous cancer comprising both histological and molecular subtypes. Using a non-invasive modality method to trigger these subtypes as early as possible can aid clinicians in establishing individualized treatment.
Purpose:The study aimed to clarify the value of the Apparent Diffusion Coefficient (ADC) of EC MRI in determining molecular subtypes.
Material and Methods:We retrospectively recruited 109 patients with pathologically proven EC (78 endometrioid cancers and 31 non-endometrioid cancers) with available molecular classification from a tertiary centre. MRI was prospectively performed a month prior to surgery; images were blindly interpreted by two experienced radiologists with consensus reading. The ADC value was measured by an experienced radiologist on the commercially available processing workstation. Interoperator measurement consistency was calculated.
Results:Our sample comprised 17 PLOE, 32 MSI-H, 31 NSMP, and 29 P53abn ECs. Clinical information did not differ significantly among the groups. The maximum diameter and volume of the lesions differed among the groups. The ADC value in the maximal area (ADCarea) or region of interest (ROI, ADCroi) in the P53abn group was higher than that in the other groups (894.0 ±12.6 and 817.5 ± 83.3 x10-6 mm2/s). The ADC mean values were significantly different between the P53abn group and the other groups (P = 0.000). The nomogram showed the highest discriminative ability to distinguish P53abn EC from other types (AUC: 0.859).
Conclusion:Our results have suggested the quantitative MR characteristics (ADC values) derived from preoperative EC MRI to provide useful information in preoperatively determining P53abn cancer.
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A Video-based Automated Tracking and Analysis System of Plaque Burden in Carotid Artery using Deep Learning: A Comparison with Senior Sonographers
Authors: Wenjing Gao, Mengmeng Liu, Jinfeng Xu, Shaofu Hong, Jiayi Chen, Chen Cui, Siyuan Shi, Yinghui Dong, Di Song and Fajin DongBackground and Objective:The incidence of stroke is rising, and it is the second major cause of mortality and the third leading cause of disability globally. The goal of this study was to rapidly and accurately identify carotid plaques and automatically quantify plaque burden using our automated tracking and segmentation US-video system.
Methods:We collected 88 common carotid artery transection videos (11048 frames) with a history of atherosclerosis or risk factors for atherosclerosis, which were randomly divided into training, test, and validation sets using a 6:3:1 ratio. We first trained different segmentation models to segment the carotid intima and adventitia, and calculate the maximum plaque burden automatically. Finally, we statistically analyzed the plaque burden calculated automatically by the best model and the results of manual labeling by senior sonographers.
Results:Of the three Artificial Intelligence (AI) models, the Robust Video Matting (RVM) segmentation model's carotid intima and adventitia Dice Coefficients (DC) were the highest, reaching 0.93 and 0.95, respectively. Moreover, the RVM model has shown the strongest correlation coefficient (0.61±0.28) with senior sonographers, and the diagnostic effectiveness between the RVM model and experts was comparable with paired-t test and Bland-Altman analysis [P= 0.632 and ICC 0.01 (95% CI: -0.24~0.27), respectively].
Conclusion:Our findings have indicated that the RVM model can be used in ultrasound carotid video. The RVM model can automatically segment and quantify atherosclerotic plaque burden at the same diagnostic level as senior sonographers. The application of AI to carotid videos offers more precise and effective methods to evaluate carotid atherosclerosis in clinical practice.
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Super-resolution based Nodule Localization in Thyroid Ultrasound Images through Deep Learning
Authors: Jing Li, Qiang Guo, Shiyi Peng and Xingli TanBackground:Currently, it is difficult to find a solution to the inverse inappropriate problem, which involves restoring a high-resolution image from a low-resolution image contained within a single image. In nature photography, one can capture a wide variety of objects and textures, each with its own characteristics, most notably the high-frequency component. These qualities can be distinguished from each other by looking at the pictures.
Objective:The goal is to develop an automated approach to identify thyroid nodules on ultrasound images. The aim of this research is to accurately differentiate thyroid nodules using Deep Learning Technique and to evaluate the effectiveness of different localization techniques.
Methods:The method used in this research is to reconstruct a single super-resolution image based on segmentation and classification. The poor-quality ultrasound image is divided into several parts, and the best applicable classification is chosen for each component. Pairs of high- and low-resolution images belonging to the same class are found and used to figure out which image is high-resolution for each segment. Deep learning technology, specifically the Adam classifier, is used to identify carcinoid tumors within thyroid nodules. Measures, such as localization accuracy, sensitivity, specificity, dice loss, ROC, and area under the curve (AUC), are used to evaluate the effectiveness of the techniques.
Results:The results of the proposed method are superior, both statistically and qualitatively, compared to other methods that are considered one of the latest and best technologies. The developed automated approach shows promising results in accurately identifying thyroid nodules on ultrasound images.
Conclusion:The research demonstrates the development of an automated approach to identify thyroid nodules within ultrasound images using super-resolution single-image reconstruction and deep learning technology. The results indicate that the proposed method is superior to the latest and best techniques in terms of accuracy and quality. This research contributes to the advancement of medical imaging and holds the potential to improve the diagnosis and treatment of thyroid nodules.
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Microstructure and Perfusion Alterations of Globus Pallidus in Neonates with Hyperbilirubinemia
Authors: Yi Zhang, Juan Zhang, Yu-Chen Chen, Jin-Xia Zheng and Shaohua DingBackground:Previous studies have indicated the abnormality of the globus pallidus in neonates with hyperbilirubinemia.
Objective:This study aims to explore the microstructure and cerebral perfusion of globus pallidus in neonatal hyperbilirubinemia by using Diffusion Tensor Imaging (DTI) and Arterial Spin Labeling (ASL) approaches.
Methods:Thirty-seven neonates were enrolled in this study, which were classified into Bilirubin-Induced Neurologic Dysfunction (BIND) group (hyperbilirubinemia with BIND, n=12), non-BIND group (hyperbilirubinemia without BIND, n=15), and healthy controls (HC) group (n=10). The quantitative values of globus pallidus were calculated from DTI, including the Apparent Diffusion Coefficient (ADC), the Fractional Anisotropy (FA), and Volume Ratio (VR) values. Additionally, the relative Cerebral Blood Flow (rCBF) values were obtained from ASL.
Results:It was observed that the mean DTI signal of globus pallidus was significantly different among the three groups (p < 0.05). However, there were no significant differences in the rCBF of globus pallidus among the three groups (p > 0.05). A positive correlation was also observed between the fractional anisotropy (FA) value and serum bilirubin level (r = 0.561, p = 0.002), while the VR value showed a negative correlation with serum bilirubin level (r=-0.484, p=0.011). The area under the curve (AUC) of FA, VR, and FA and VR combined was 0.897, 0.858, and 0.933, respectively.
Conclusion:The alterations of microstructure in globus pallidus, especially FA and VR value, may be valuable and sensitive at the early stage of hyperbilirubinemia encephalopathy, suggesting that early hyperbilirubinemia may lead to cytotoxic edema and decreased permeability of the cell membrane.
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Rare Columnar Cell Variant of Papillary Thyroid Carcinoma with Cervical Spine Metastasis: A Case Report
Authors: Jihye Yu, Goeun Yang, Ha Yeun Oh and Yoon Jong RyuBackgroundColumnar cell carcinoma is a rare subtype of papillary thyroid carcinoma (CCV-PTC) that accounts for only 0.15% to 0.2% of all Papillary Thyroid Carcinomas (PTCs). It has aggressive behavior but a better prognosis than anaplastic thyroid carcinoma.
Case PresentationA 64-year-old female presented with a huge thyroid mass resulting in compressive myelopathy and was diagnosed as CCV-PTC, not anaplastic carcinoma. After multidisciplinary discussions, we decided to proceed with otolaryngological, thoracic, and orthopaedic surgery. All tumours were unresectable, and we planned to proceed with R2 resection to resolve the gait disturbance and anterior fusion to resolve spinal instability.
ConclusionAdvanced-stage thyroid cancer is relatively uncommon, but desirable treatment effects can be expected through accurate pathological diagnosis. Immunohistochemical staining and tissue-specific markers can be helpful.
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A Systematic Review on Deep Learning Model in Computer-aided Diagnosis for Anterior Cruciate Ligament Injury
Authors: Herman Herman, Yogan Jaya Kumar, Sek Yong Wee and Vinod Kumar PerhakaranIntroductionIn developing Computer-Aided Diagnosis (CAD), a Convolutional Neural Network (CNN) has been commonly used as a Deep Learning (DL) model. Although it is still early, DL has excellent potential in implementing computers in medical diagnosis.
MethodsThis study reviews the use of DL for Anterior Cruciate Ligament (ACL) tear diagnosis. A comprehensive search was performed in PubMed, Embase, and Web of Science databases from 2018 to 2024. The included study criteria used MRI images to evaluate ACL tears, and the diagnosis of ACL tears was performed using the DL model. We summarized the paper by reporting their model accuracy, model comparison with arthroscopy, and explainable.
ResultsAI implementation in tabular format; we conclude that many medical professionals believe that arthroscopic diagnosis is the most reliable method for diagnosing ACL tears. However, due to its intrusive treatment, CAD is projected to be able to produce similar outcomes from MRI scan results. To gain the trust of physicians and meet the demand for reliable knee injury detection systems, an algorithm for CAD should also meet several criteria, such as being transparent, interpretable, explainable, and easy to use. Therefore, future works should consider creating an Explainable DL model for ACL tear diagnosis. It is also essential to evaluate the performance of this Explainable DL model compared to the gold standard of arthroscopy diagnosis.
ConclusionThere are issues regarding the need for Explainable DL in CAD to increase confidence in its result while also highlighting the importance of the involvement of medical practitioners in system design. There is no funding for this work.
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Intratumoral and Peritumoral Edema Radiomics Based on Fat-Suppressed T2-Weighted Imaging for Preoperative Prediction of Triple-Negative Breast Cancer
Authors: Ruihong Sun, Yun Hu, Xuechun Wang, Zengfa Huang, Yang Yang, Shutong Zhang, Feng Shi, Lei Chen, Hongyuan Liu and Xiang WangAim:Our aim was to explore the feasibility of using radiomics data derived from intratumoral and peritumoral edema on fat-suppressed T2-weighted imaging (T2 FS) to distinguish triple-negative breast cancer (TNBC) from non-triple-negative breast cancer (non-TNBC).
Methods:This retrospective study enrolled 174 breast cancer patients. According to the MRI examination time, patients before 2021 were divided into training (n = 119) or internal test (n = 30) cohorts at a ratio of 8:2. Patients from 2022 were included in the external test cohort (n = 25). Four regions of interest for each lesion were defined: intratumoral regions, peritumoral edema regions, regions with a combination of intratumoral and peritumoral edema, and regions with a combination of intratumoral and 5-mm peritumoral. Four radiomic signatures were built using the least absolute shrinkage and selection operator (LASSO) method after selecting features. Furthermore, a radio mic-radiological model was constructed using a combination of intratumoral and peritumoral edema regions along with clinical-radiologic features. Area under the receiver operating characteristic curve (AUC) calculations, decision curve analysis, and calibration curve analysis were performed to assess the performance of each model.
Results:The radiomic-radiological model showed the highest AUC values of 0.906 (0.788-1.000) and 0.825 (0.622-0.947) in both the internal and external test sets, respectively. The radiology-radiomic model exhibited excellent predictive performance, as evidenced by the calibration curves and decision curve analysis.
Conclusion:The ensemble model based on T2 FS-based radiomic features of intratumoral and peritumoral edema, along with radiological factors, performed better in distinguishing TNBC from non-TNBC than a single model. We explored the possibility of developing explainable models to support the clinical decision-making process.
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Magnetic Resonance Images Segmentation of Multifidus based on Dense-unet and Superpixel
Authors: Rui Xu, Xin Guo, Zimin Wang, Tingqiang Guan and Yue ZhouBackgroundLumbar disc herniation (LDH) is a common clinical condition causing lower back and leg pain. Accurate segmentation of the lumbar discs is crucial for assessing and diagnosing LDH. Magnetic resonance imaging (MRI) can reveal the condition of articular cartilage. However, manual segmentation of MRI images is burdensome for physicians and needs to be more efficient.
ObjectiveIn this study, we propose a method that combines UNet and superpixel segmentation to address the problem of loss of detailed information in the feature extraction phase, leading to poor segmentation results at object edges. The aim is to provide a reproducible solution for diagnosing patients with lumbar disc herniation.
MethodsWe suggest using the network structure of UNet. Firstly, dense blocks are inserted into the UNet network, and training is performed using the Swish activation function. The Dense-UNet model extracts semantic features from the images and obtains rough semantic segmentation results. Then, an adaptive-scale superpixel segmentation algorithm is applied to segment the input images into superpixel images. Finally, high-level abstract semantic features are fused with the detailed information of the superpixels to obtain edge-optimized semantic segmentation results.
ResultsEvaluation of a private dataset of multifidus muscles in magnetic resonance images demonstrates that compared to other segmentation algorithms, this algorithm exhibits better semantic segmentation performance in detailed areas such as object edges. Compared to UNet, it achieves a 9.5% improvement in the Dice Similarity Coefficient (DSC) and an 11.3% improvement in the Jaccard Index (JAC).
ConclusionThe experimental results indicate that this algorithm improves segmentation performance while reducing computational complexity.
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Occurrence of Residual Breast Tumors and Efficacy of MRI in their Detection after Vacuum-assisted Excisional Biopsy
Authors: Qun Wei, Qing Zheng, Yifeng Gu, Rongyue Teng and Wenhe ZhaoBackgroundResidual breast tumors may remain after vacuum-assisted excisional biopsy (VAEB).
ObjectiveTo determine the incidence of residual breast tumors in patients after VAEB and the efficacy of magnetic resonance imaging (MRI) in detecting these tumors.
MethodsThis retrospective analysis examined patients who received VAEB before a diagnosis of breast cancer (BC) at our hospital from 2015 to 2019. The incidence of residual tumors after VAEB was determined by MRI and pathological examination. The diagnostic value of MRI in detecting residual tumors was determined for all patients and different subgroups. Logistic regression analysis was used to identify factors associated with residual tumors.
ResultsWe examined 147 patients and obtained pathological samples from 146 patients, including 103 (70.5%) with residual tumors and 43 (29.5%) without residual tumors. The MRI examinations demonstrated the complete tumor resection rate was 48.9%. Compared to the pathological results, MRI had a positive predictive value of 77.8%, negative predictive value of 48.8%, specificity of 65.6%, and sensitivity of 60.7%. Further analysis indicated that MRI had moderate accuracies for patients with stage pT-1 (71.9%), stage pTNM-IA (73.1%), and luminal B subtype (78.3%). Binary logistic regression analysis showed that the risk of tumor residue correlated with the pathological stage.
ConclusionTumor residue is common after VAEB, and MRI has limited accuracy in detecting these residual tumors. However, for small breast tumors and luminal B subtype BC, MRI had higher accuracy in the detection of residual tumors. The risk of tumor residue is closely associated with the pathological stage.
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Colour Doppler Sonography of the Ovarian Vein: Recognition and Associated Lesions
Authors: Chen Su, Tiezheng Wang and Hengtao QiAimThe purpose of this study was to evaluate the diagnostic value of colour Doppler sonography for ovarian veins. The clinical incidence of ovarian venous lesions is relatively low and often overlooked. The ovarian veins are located deep in the pelvis, and they are relatively elongated, which could make medical imaging more difficult. Therefore, there is limited literature on the diagnosis of ovarian venous disease. The purpose of this study was to evaluate the diagnostic value of colour Doppler sonography towards ovarian vein.
MethodsA total of 37 consecutive patients with clinically suspected ovarian venous disorders were included. All the patients underwent colour Doppler sonography. CTV was performed in 31 patients, while retrograde phlebography was performed in 6 patients. CT/phlebography was the established diagnostic criterion for ovarian vein disorders. The SPSS 22.0 program was used for statistical analysis. Sensitivity, specificity, and positive and negative predictive values for colour Doppler sonography were calculated. k-test was used to evaluate consistency between colour Doppler sonography and CT/phlebography.
ResultsIn the 37 patients,18 cases were positive for ovarian vein disorders and 19 cases were negative, as assessed with colour Doppler sonography. The associated lesions included ovarian vein thrombosis (7 cases), ovarian varicocele (3 cases), and ovarian venous leiomyoma (8 cases). The calculated values of sensitivity, specificity, and positive and negative predictive value were 94.4%, 94.7%, 94.4%, and 94.7%, respectively. The overall accuracy rate was 94.9%. The K level of the degree of agreement between CT/phlebography and colour Doppler sonography was 0.892.
ConclusionColour doppler sonography can provide sufficient imaging information. In clinical ultrasonography, attention should be paid to recognizing and detecting ovarian venous lesions.
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Deep Learning-based Thigh Muscle Investigation Using MRI For Prosthetic Development for Patients Undergoing Total Knee Replacement (TKR)
Authors: Vinod Arunachalam and Kumareshan NBackgroundA prosthetic device is designed based on the quantitative analysis of muscle MRI which will improve the muscle control achieved with functional electrical stimulation/ guided robotic exoskeletons. Electromyography (EMG) provides muscle functionality information while MRI provides the physiological and functionality of muscles. The sensor feedbacks were used for the bionic prosthesis, but the length of muscle using image processing was not correlated .
ObjectiveTo investigate and perform qualitative and quantitative assessment of thigh muscle using MRI. The objective of the work is to improve the existing VAG signal classification method to diagnose abnormality using MRI for patients undergoing Total knee replacement (TKR).
MethodsA deep learning method for qualitative and quantitative assessment of thigh muscle is done using MRI. In existing prosthetic devices, electrical measurements of a person’s muscles are obtained using surface or implantable electrodes. Several methods were used for the classification and diagnostic processes. The existing methods have drawbacks in feature extraction and require experts to design the system. This work combines medical image processing and orthopaedic prosthetics to develop a therapeutic method.
Results & DiscussionThis design provides much more precise control of prosthetic limbs using the image processing technique. The hybrid CNN swarm-based method measures the muscle structure and functions. Along with the sensor readings, these details are combined for prosthetic control. The implementation was carried out in MATLAB, Sketchuppro, and Arduino IDE.
ConclusionA combined swarm intelligence and deep learning method were proposed for qualitative and quantitative assessment of thigh muscle. The prosthetic device choice was done from the scanned MRI image like Humerus-T prosthetics, segmental prosthesis and arthrodesis prosthesis. The investigation was done for the Total knee replacement (TKR) approach
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Gait Analysis of Knee Joint Walking Based on Image Processing
Authors: Shuai Wang and Jihe ZhouBackgroundWith the in-depth development of assistive treatment devices, the application of artificial knee joints in the rehabilitation of amputees is becoming increasingly mature. The length of residual limbs and muscle strength of patients have individual differences, and the current artificial knee joint lacks certain adaptability in the personalized rehabilitation of patients.
PurposeIn order to deeply analyze the impact of different types of artificial knee joints on the walking function of unilateral thigh amputees, improve the performance of artificial knee joints, and enhance the rehabilitation effect of patients, this article combines image processing technology to conduct in-depth research on the walking gait analysis of different artificial knee joints of unilateral thigh amputees.
MethodsThis article divides patients into two groups: the experimental group consists of patients with single leg amputation, and the control group consists of patients with different prostheses. An image processing system is constructed using universal video and computer hardware, and relevant technologies are used to recognize and track landmarks; Furthermore, image processing technology was used to analyze the gait of different groups of patients. Finally, by analyzing the different psychological reactions of amputees, corresponding treatment plans were developed.
ResultsDifferent prostheses worn by amputees have brought varying degrees of convenience to life to a certain extent. The walking stability of wearing hydraulic single axis prosthetic joints is only 79%, and the gait elegance is relatively low. The walking stability of wearing intelligent artificial joints is as high as 96%. Elegant gait is basically in good condition.
ConclusionImage processing technology helps doctors and rehabilitation practitioners better understand the gait characteristics and rehabilitation progress of patients wearing different artificial knee joints, providing objective basis for personalized rehabilitation of patients.
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3D-Bioprinting and AI-empowered Anatomical Structure Designing: A Review
Authors: Neha Bhardwaj, Meenakshi Sood and Sandeep Singh GillBackground:The recent advancements and detailed studies in the field of 3D bioprinting have made it a promising avenue in the field of organ shortage, where many patients die awaiting transplantation. The main challenges bioprinting faces are precision during printing, vascularization, and cell proliferation. Additionally, overcoming these shortcomings requires experts from engineering, medicine, physics, etc., and if accomplished, it will significantly benefit humankind.
Objective:This paper covers the general roadmap of the bioprinting process, different kinds of bioinks, and available bioprinters. The paper also includes designing the anatomical structure, which is the first phase of the bioprinting process, and how AI has facilitated this entire process of 3D printing in healthcare and associated applications like medical modelling and disease modelling.
Methods:The process of 3D bioprinting involves meticulous structure designing of the anatomical structure under study, which forms the base of the entire bioprinting process. One of the significant applications of 3D printing in healthcare is Medical Modelling and Disease Modelling, which requires the detection of disease in anatomy and its delineation from the rest of anatomy for meticulous creation of ROI using sophisticated segmentation software(s) for the construction of 3D models of diseased anatomy and healthy anatomical surroundings.
Conclusion:The study concluded that bioprinting is the future of the worldwide organ transplantation crisis. Anatomical accuracy is an important aspect that must be considered while producing 3D models. The reproduction of patient-specific 3D models requires human rights and ethics approval under four principles of ethics in healthcare: autonomy, non-maleficence, beneficence, and justice.
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The Association of Body Composition Parameters Measured by Computed Tomography with Cancer Stage, Prognosis, and Survival in Patients with Renal Cell Carcinoma
Authors: Seray Gizem Gur Ozcan, Deniz Barali and Anil ErkanObjectiveThis study aims to investigate the association of preoperative body composition parameters, measured by computed tomography in patients undergoing surgery for renal cell carcinoma, with its stage and to survey the relationship with postoperative hospitalization duration and survival.
MethodsDemographic data, pathology results, cancer stages, and hospitalization duration of 104 patients undergoing surgery at the urology clinic due to renal cell carcinoma between 2019 and 2023 were analyzed retrospectively. On computed tomography scans acquired during diagnosis, visceral adipose tissue, subcutaneous adipose tissue, total adipose tissue, and skeletal muscle area were measured. The ratios of body composition parameters were computed.
ResultsWhen the correlation between survival time and body composition in deceased patients was analysed, a moderate but significant correlation was observed between skeletal muscle area value and total adipose tissue / skeletal muscle area ratio (r=0.630, p=0.001; r=0.598, p=0.002). A significant and strong correlation was observed between total adipose tissue value and survival (r=0.704, p<0.001). Subcutaneous adipose tissue / skeletal muscle area was found to be an independent risk factor associated with mortality, and a ratio of 0.98 or less increased the mortality risk approximately 16-fold.
ConclusionThe relationship between body composition parameters measured by computed tomography, which can be easily evaluated pre-treatment, and mortality, postoperative recovery and length of hospital stay can be evaluated, giving clinicians an idea about the potential difficulties that patients may encounter during the treatment process. For this purpose, the subcutaneous adipose tissue / skeletal muscle area ratio is the most helpful parameter that can be used.
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Effects of Glutamine Synthetase on Neovascularization in Glioma: In Vivo MR Vessel Size Imaging and Histology
Authors: Tianwei Song, Dandan Wang, Yanan Zhang, Hong Hao, Guodong Li, Xiping Ding, Zongtao Hu, Zhi Zhang, Yan Liu, Hongzhi Wang, Xianglin Li and Junchao QianBackground:Glutamine Synthetase (GS) could induce vascular sprouting through the improvement of endothelial cell migration in inflammatory diseases. MR vessel-size imaging has been proposed as a valuable approach for visualizing the underlying angiogenic processes in the brain.
Objective:This study aims to investigate the role of GS in the neovascularization of gliomas through the utilization of MR vessel-size imaging and histopathological techniques.
Methods:In this exploratory animal study, we randomly divided the C6 glioma rat models into a control group and an L-methionine sulfoximine (MSO) treatment group. Daily intraperitoneal injections were administered for three consecutive days, starting from day 10 following the implantation of C6 glioma cells in rats. Subsequently, MR vessel size imaging was conducted using a BRUKER 7 T/200 mm MRI scanner, and the MRI results were validated through histopathological examination.
Results:A significant decrease in microvessel density was observed in both the tumor periphery and center areas in the MSO treatment group compared to that in the control group. The mean vessel diameter (mVD) and vessel size index (VSI) did not exhibit significant changes compared to the control group. Moreover, the staining intensity of platelet endothelial cell adhesion molecule-1 (CD31) and GS in the tumor periphery was significantly decreased in the MSO treatment group. Additionally, the MSO treatment demonstrated a substantial inhibition of tumor growth.
Conclusion:GS inhibitors significantly reduced angiogenesis in the periphery area of C6 glioma, exerting an inhibitory effect on tumor progression. Thus, GS inhibitors could be potential therapeutic agents for treating glioma. Additionally, in vivo MR vessel size imaging detects changes in vascular-related parameters after tumor treatment, making it a promising method for detecting neovascularization in glioma.
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The Relationship between Breast Cancer Subtypes, Prognostic Factors, and Apparent Diffusion Coefficient Histogram Analysis
BackgroundDiffusion Magnetic Resonance Imaging (MRI) is a useful method to evaluate tumor biology and tumor microstructure. The apparent diffusion coefficient (ADC) value correlates negatively with the cellular density of the tumor.
ObjectiveThis study aimed to investigate the effectiveness of the ADC histogram analysis in showing the relationship between breast cancer prognostic factors and ADC parameters.
MethodsThis study is a retrospective observational descriptive study. ADC histogram parameters were evaluated in all tumor volumes of 67 breast cancer patients. Minimum, 5, 10, 25, 50, 75, 90, 95 percentiles, maximum, mean, median ADC values, kurtosis, and skewness were calculated. Breast MRI examinations were performed on a 3T MR scanner. We evaluated the fibroglandular tissue density of bilateral breasts, background enhancement, localization of masses, multifocality-multicentricity, shape, rim, internal contrast enhancement, and kinetic curve on breast MRI. BI-RADS scoring was performed according to breast MRI. Pathologically, histologic type, histologic grade, HER 2, Ki 67, ER-, and PR status were evaluated.
ResultsA significant correlation was found between tumor volume and ADC scores. There is a significant correlation between min ADC values (p< 0.031), max ADC (p< 0.001), and skewness (p< 0.019). A significant correlation was found between tumor kurtosis and lymph nodes (p< 0.029). There was a significant difference in ADC mean, ADC10%, ADC25%, ADC50%, ADC75%, ADC90%, ADC 95% and ADCmax values depending on ER-and PR-status. (for ER p = 0.004, p = 0.018, p = 0.010, p = 0.008, p = 0.004, p = 0.004, p = 0.02, p = 0.02 and p = 0.038, for PR p < 0.001, p = 0.028, p = 0.011, p = 0.001, p < 0.001, p =<0.001, p < 0.001, and p < 0.001, respectively; p < 0.05). These values were lower in ER-and PR-positive status than in ER-and PR-negative receptor status. According to HER2 status, there was a statistically significant difference in ADC5% and measurements of the lesions (p = 0.041; p < 0.05). Our study found no significant correlation between other prognostic factors, such as histological grade, Ki-67 indices, and ADC values.
ConclusionOur study found a significant difference between tumor volume, ER- and, PR status, HER2, and lymph node involvement, and some ADC values among prognostic factors for breast cancer. Furthermore, ADC histogram analysis can provide additional value in predicting some prognostic factors.
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Evaluating Ocular Blood Flow in Diabetic Macular Edema using Three-dimensional Pseudocontinuous Arterial Spin Labeling
Authors: Jiao Sun, Huihui Wang and Yan-ling WangBackgroundAlterations in ocular blood flow play an important role in the pathogenesis of diabetic macular edema; however, this remains unclear.
ObjectivesThis study aimed to investigate ocular blood flow in eyes with or without diabetic macular edema using arterial spin labeling.
MethodsThis cross-sectional study included 118 eyes of 65 patients with diabetic retinopathy analyzed between November 2018 and December 2019. We included a total of 53 eyes without diabetic macular edema (mean [SD] age, 57.83 [7.23] years; 29 men [54.7%]) and 65 eyes with diabetic macular edema (mean [SD] age, 60.11 [7.63] years; 38 men [58.5%]). Using a 3.0-T magnetic resonance imaging, participants were imaged with arterial spin labeling with multiple post-labeling delays.
ResultsThe mean ocular blood flow at post-labeling delays of 1.5 and 2.5 s was significantly lower in eyes with diabetic macular edema among patients with diabetic retinopathy compared with the remaining subgroups (P=0.022 and P <0.001, respectively). The mean ocular blood flow exhibited a significant decrease in eyes with diabetic macular edema when the post-labeling delay was set at 2.5 s in the nonproliferative and proliferative diabetic retinopathy groups, compared with the remaining subgroups (P=0.005 and P=0.002, respectively). The cutoff points of ocular blood flow at post-labeling delays of 1.5 s and 2.5 s were 9.40 and 11.10 mL/100 g/min, respectively.
ConclusionThree-dimensional pseudocontinuous arterial spin labeling can identify differences in the ocular blood flow of patients with diabetic eyes with and without diabetic macular edema.
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MR Imaging of Typical Ovarian Hemangioma: A Case Report
Authors: Xiaoli Yu, Qingqing Zheng, Min Ai, Hanghang Zhang, Chuanming Li, Junbang Feng and Jing ZhouBackgroundOvarian hemangioma is an extremely rare tumor with atypical clinical manifestations, often discovered incidentally during autopsy or surgery. Approximately 60 cases have been reported in the past, but no more than 10 cases have been investigated by MRI and ultrasound (US).
Case Presentationln this paper, we reported a 51-year-old female patient with Ovarian Hemangioma who had no symptoms of abdominal pain, abnormal vaginal bleeding or discharge, or any other discomfort. Laboratory tests revealed an elevated serum carbohydrate antigen (CA125) of 48.99U/ml (reference range: 0-35U/ml). Multiparametric 3.0T magnetic resonance imaging (MRI) showed a cystic solid mass with a clear boundary and regular shape in the left ovarian area and minimal ascites in the abdominal cavity. The histological examination of the mass confirmed an ovarian hemangioma.
ConclusionThe MRI findings of ovarian hemangiomas are highly similar to those observed in hepatic hemangiomas, emphasizing the distinctive radiological characteristics specific to this condition in the ovary. This paper presents an overview of the typical MRI findings associated with ovarian hemangioma, which holds great importance for accurate diagnosis and effective treatment.
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Identification of Severe Grading in Knee OsteoArthritis from MRI using Ensemble Deep Learning
By Jaber AlyamiBackground:Accurate finding of Knee Osteoarthritis (KOA) from structural Magnetic Resonance Imaging (MRI) is a difficult task and is greatly subject to user variation. Furthermore, the identification of knee osteoarthritis (KOA) from MRI scans presents a challenge due to the limited information available. A novel methodology using an ensemble Deep Learning algorithm, combining EfficientNet-B3 and ResNext-101 architectures, aims to forecast KOA advancement, bridging the identified gap in clinical trials.
Objectives:The study aims to develop a precise predictive model for knee osteoarthritis using advanced deep-learning architectures and structural MRI scan data. By utilizing an ensemble technique, the model's accuracy in predicting disease development is enhanced, surpassing the limitations of traditional biomarkers.
Methods:The study used the Osteoarthritis Initiative dataset to develop an ensemble Deep Learning model that combined EfficientNet-B3 and ResNext-101 architectures. Techniques like cropping, gamma correction, and in-slice rotation were used to expand the dataset and improve the model's generalization capacity.
Results:The Deep Learning model demonstrated 93% validation accuracy on the OAI dataset, accurately capturing subtle patterns of knee osteoarthritis progression. Augmentation approaches enhanced its resilience.
Conclusion:Our ensemble Deep Learning approach, using ResNext-101 and EfficientNet-B3 architectures, accurately predicts knee osteoarthritis courses using structural MRI data, demonstrating the importance of data augmentation for improved predictive tools.
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Effects of Iodinated Contrast-enhanced CT on Urinary Iodine Levels in Postoperative Patients with Differentiated Thyroid Cancer
Authors: Shengwei Fang, Suyang Han, Peipei Zhang and Chunlei ZhaoAimsThis study aims to observe the fluctuating urine iodine levels in patients with differentiated thyroid cancer (DTC) following iodinated contrast-enhanced computed tomography (eCT) scans.
BackgroundThe presence of iodine in iodinated contrast agents (ICAs) can impede the effectiveness of radioactive iodine treatment (RAIT) and diagnostic scans in individuals diagnosed with DTC, as it can engage in competitive interactions with 131I. According to established guidelines, it is recommended to postpone RAIT for a period of three to four months in individuals who have had prior exposure to ICAS. The measurement of spot urine iodine concentration is a valuable indicator for assessing the overall iodine content throughout the body.
ObjectiveThe objective is to identify the optimal timing for administering postoperative RAIT in DTC patients.
MethodsAt various time points after surgery, a cohort of 467 random urine samples (126 male samples, 341 female samples, age (45±12 years)) was obtained from 269 DTC patients. The samples were analyzed for urinary iodine and urinary creatinine levels, and the urinary iodine/urine creatinine ratio (I/Cr) was computed. All samples were divided into two groups according to whether eCT before operation: the non-enhanced CT (eCT-) group and the enhanced CT (eCT+) group. The urine samples in the eCT- group were categorized into four subgroups according to the duration of strict low iodine diet (LID): (eCT-I+) no LID; (eCT-I-2W) 2 weeks of LID; (eCT-I-4W) 4 weeks of LID; and (eCT-I-6W) 6 weeks of LID. The last three groups were merged into the eCT- and effective LID group (eCT- I-). The urine samples from the eCT+ group were categorized into five subgroups: (0.5M eCT+)0.5 month after eCT+; (1M eCT+)1 month after eCT+; (2M eCT+) 2 months after eCT+; (3M eCT+) 3 months after eCT+; (≥4M eCT+) ≥4 months after eCT+. In addition, the patients within 2 months after eCT+ were divided into 2 groups according to their LID: no effective LID group (eCT+ I+) and effective LID group (eCT+ I-). Utilizing the Kruskal-Wallis and Mann-Whitney U rank sum tests, the differences in I/Cr between groups were compared.
ResultsIn the eCT-group, the I/Cr ratios of eCT-I-2W, eCT-I-4W, and eCT-I-6W were significantly lower than those of eCT-I+ (χ2 values: 4.607.99, all P 0.05). However, there was no significant difference in I/Cr between eCT-I-2W, eCT- I-4W, and eCT-I-6W (2 values: 0.591.31, all P > 0.05). Significantly higher I/Cr values were observed in 0.5M eCT+ and 1M eCT+ than in eCT-I+ (χ2 values: 3.22 and 2.18, respectively, all P<0.05). There was no significant difference in I/Cr between 2M eCT+ and eCT-I+ (χ2 = 0.76, P = 0.447). The I/Cr rations of 3M eCT+, ≥4M eCT+ were not significantly different with eCT-I- (χ2 values: 1.76; 0.58; all P > 0.05). However, they were considerably lower than eCT-I+ (χ2 values: 7.03; 5.22; all P<0.05). The I/Cr for patients who underwent eCT within two months (eCT+ I-, eCT+ I+) did not differ significantly (χ2 = 1.79, P = 0.073).
ConclusionFor patients who are considering receiving radioactive iodine therapy (RAIT) following a diagnosis of differentiated thyroid cancer (DTC), it is recommended that the interval between RAIT treatment and enhanced computed tomography [eCT] scans be conducted at least three months.
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Femoral Neck Shaft Angle Measurement for Differentiating Femoral Head Stress Fracture from Avascular Necrosis
Authors: Dong Kyu Kim, Kyu-Chong Lee, Kyung-Sik Ahn and Chang Ho KangObjective:The study aimed to evaluate whether the measurement of Femoral Neck Shaft Angle (FNSA) can be helpful in differentiating femoral head Stress Fracture (SF) from Avascular Necrosis (AVN).
Methods:From September 2019 to April 2022, sixty-four patients [median age 32.0 years, interquartile range (IQR) 23.0–39.0 years] who underwent both hip radiograph and Magnetic Resonance Imaging (MRI) and diagnosed as femoral head SF or AVN were included in our retrospective study. Patients were divided into as having either femoral head SF (n = 34) or AVN (n = 30). The FNSA was measured in anteroposterior hip radiography. Continuous values were compared using the Mann-Whitney U test. The assessment of the predictive value of FNSA for femoral head SF was performed by Receiver Operating Characteristic (ROC) analysis.
Results:The FNSA was significantly higher in patients with SF (median 133.5°, IQR 128.0–136.7°) than those with AVN (median 127.5°, IQR 124.0–132.0°) (p = 0.001). In addition, the FNSA was significantly higher in SF femurs (median 134.8°, IQR 129.2–137.4°) than in contralateral normal femurs (median 127.1°, IQR 124.3–132.5°) in patients with unilateral femoral head SF (n = 30) (p < 0.001). In ROC analysis, the sensitivity, specificity, and Area Under the Curve (AUC) for predicting the femoral head SF were 77.3%, 63.3%, and 0.785 (95% confidence interval: 0.666–0.905), respectively, at a cutoff of 130.2°.
Conclusion:Increased FNSA was associated with femoral head SF; thus, measurement of FNSA could be helpful for differentiating femoral head SF from AVN.
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Feasibility of Point Shear Wave Elastography for Evaluating Renal Cortical Thickness: A Prospective Study
Authors: Fahad Almutairi and Jaber AlyamiBackgroundChronic Kidney Disease (CKD) affects individuals of different age groups worldwide. Moreover, CKD is associated with several risk factors, including obesity, lifestyle, and hypertension, which are common in the Middle East. Ultrasonography is the examination of choice for CKD. In recent years, Shear Wave Elastography (SWE) has developed through the continued development of ultrasound and received substantial attention ;therefore, it can be used to measure tissue stiffness. The study aimed to use point Shear Wave Elastography (p-SWE) to determine the correlation between diabetes and cortical renal thickness in detecting pathologies.
MethodsThis study was performed at the King Abdul-Aziz University Hospital. We examined 61 patients who underwent SWE. The patients were classified into two groups based on the presence or absence of type 2 Diabetes Mellitus (DM).
ResultsThe results showed that there was a significant correlation between cortical stiffness and DM duration [p<0.005]. In addition, there was a negative correlation between cortical stiffness and cortical thickness [p=0.147] in patients with DM. Moreover, the eGFR decreased with an increase in cortical stiffness [p=0.499]. The cortical thickness in patients with and without DM was 0.750 ± 0.2 kPa and 0.788 ± 0.4 kPa, respectively. The kidney stiffness in patients with DM and control patients was 8.5 ± 8.6 cm and 14.0 ± 25.16 cm, respectively.
ConclusionThis study showed that kidney p-SWE measurements were reliable. Therefore, further studies assessing kidney stiffness in patients with and without people with diabetes are recommended.
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Identifying Predictors for Hypoplastic Aortic Arch (HAA) in Pediatric Patients with Complex Coarctation of the Aorta (CoA)
More LessObjectiveHAA is a significant risk factor in complex CoA patients. We conducted a retrospective study to explore the relationship between HAA and other cardiovascular factors.
MethodsWe analyzed 103 patients diagnosed with complex CoA using CT angiography and echocardiography. Aortic diameter was measured at six levels, and severe coarctation was defined as coarctation site to diaphragmatic level ratio (CDR) < 50%. Correlations between non-HAA and HAA groups were assessed. Univariate and multivariate logistic regression identified HAA risk factors.
ResultsAmong 103 children with complex CoA, 55 were in the non-HAA group and 48 in the HAA group. The incidence of PDA (56.3% vs. 32.7%, p < 0.05), severe coarctation (CDR < 50%, 81.3% vs. 34.5%, p < 0.01), and collateral arteries (39.6% vs. 0, p < 0.01) were higher in the HAA group than one in the non-HAA group. The aortic arch size was positively correlated with age and negatively correlated with severe coarctation, VSD, collateral arteries, and left heart dysfunction. Logistic regression results showed that collateral arteries were risk factors for the whole aortic arch (proximal arch OR = 11.458; p < 0.01, distal arch OR = 4.211; p < 0.05, and isthmus OR = 11.744; p < 0.01), severe coarctation (OR = 6.653; p < 0.01), and left heart dysfunction (OR = 5.149; p < 0.01) associated with isthmus hypoplasia.
ConclusionThis study highlights the prevalence of HAA in complex CoA patients and its associations with various cardiovascular factors. These insights improve diagnosis and treatment approaches.
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Effect of Liver Segments and Hepatic Fibrosis Grade on Repeatability, Reliability, and Diagnostic Efficiency of Intravoxel Incoherent Motion
Authors: Lesheng Huang, Jun Chen, Weiyin Vivian Liu, Guangjun Tian, Qian Wei, Hui Peng, Wanchun Zhang, Hongyi Li, Se Peng and Tianzhu LiuBackgroundIntravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) is considered a potential marker of hepatic fibrosis (HF).
ObjectiveTo explore the influencing factors of repeatability and reliability in IVIM-DWI parameters of ROI-based liver segments in participants with HF and healthy volunteers (HV) and to assess the diagnostic efficiency of these parameters in HF.
MethodsParticipants with early HF (EHF, n=59) or advanced HF (AHF, n=38) and HV (n=48) were recruited. Two examiners measured IVIM data using mono-, bi-exponential and stretched exponential models. The results and influencing factors of repeatability and reliability of IVIM-DWI, and the diagnostic efficiency were analyzed.
ResultsThe repeatability of D* (CV: 26.62–41.47%) and DDC (CV: 18.01–34.40%) was poor, the repeatability of ADC (CV: 4.95–9.76%), D (CV: 7.09–15.52%), f (CV: 9.35–17.15%), and α (CV: 7.48–13.81%) was better; ordered logistic regression showed statistically significant results of IVIM-derived parameters; the reliability showed no obvious trend, and ordered logistic regression showed statistically significant results of IVIM-derived parameters, groups, and partial hepatic segments (all p<0.001). IVIM-derived parameters with relatively good repeatability (CV<20%) and reliability (ICC>0.4) were used to establish regression models for differential diagnosis. The AUC of regression models was 0.744–0.783 (EHF vs. AHF), but no statistically significant parameters were found in the HV vs EHF comparison.
ConclusionIVIM-derived parameters were the most important factors affecting the repeatability and reliability, while staging of HF and hepatic segments may be the influencing factors of reliability. IVIM-derived parameters showed medium diagnostic efficiency in distinguishing between EHF and AHF.
Trial RegistrationRegistered on Clinical Trial Management Public Platform (registration code: ChiCTR2100052114, date: 17th Oct. 2021).
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Design and Development of Hypertuned Deep learning Frameworks for Detection and Severity Grading of Brain Tumor using Medical Brain MR images
Authors: Neha Bhardwaj, Meenakshi Sood and Sandeep Singh GillBackgroundBrain tumor is a grave illness causing worldwide fatalities. The current detection methods for brain tumors are manual, invasive, and rely on histopathological analysis. Determining the type of brain tumor after its detection relies on biopsy measures and involves human subjectivity. The use of automated CAD techniques for brain tumor detection and classification can overcome these drawbacks.
ObjectiveThe paper aims to create two deep learning-based CAD frameworks for automatic detection and severity grading of brain tumors – the first model for brain tumor detection in brain MR images and model 2 for the classification of tumors into three types: Glioma, Meningioma, and Pituitary based on severity grading.
MethodsThe novelty of the research work includes the architectural design of deep learning frameworks for detection and classification of brain tumor using brain MR images. The hyperparameter tuning of the proposed models is done to achieve the optimal parameters that result in maximizing the models' performance and minimizing losses.
ResultsThe proposed CNN models outperform the existing state of the art models in terms of accuracy and complexity of the models. The proposed model developed for detection of brain tumors achieved an accuracy of 98.56% and CNN Model developed for severity grading of brain tumor achieved an accuracy of 92.36% on BraTs dataset.
ConclusionThe proposed models have an edge over the existing CNN models in terms of less complexity of the structure and appreciable accuracy with low training and test errors. The proposed CNN Models can be employed for clinical diagnostic purposes to aid the medical fraternity in validating their initial screening for brain tumor detection and its multi-classification.
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Rare Metastatic Embryonal Carcinoma Resembling Lymphoma: A Case Report
Authors: Chunying Li, Xin Ji, Jinwei Luan, Juntong Du, Yang Zhou, Xinxin Wang, Ying Zhang, Sainan Guo, Jiaqi Li and Xianglan LiBackgroundEmbryonal carcinoma is a rare tissue type in germ cell tumors. According to our literature review, metastatic embryonal carcinoma misdiagnosed as lymphoma because of its high similarity to lymphoma is extremely rare and has not been reported yet.
Case PresentationA 46-year-old middle adulthood male presented with unexplained fever, night sweats, abdominal distension for 3 months, and weight loss of around 7kg during almost 6 months, which is extremely similar to lymphoma from the clinical features and imaging examinations. After a clear diagnosis, the case not only obtained the opportunity of surgery but was also exempted from radiotherapy. The treatment effect was good. We report a case of rare metastatic embryonal carcinoma, which can provide insight into the diagnosis and treatment of embryonal carcinoma.
ConclusionMetastatic embryonal carcinoma of abdominal lymph nodes can be highly similar to lymphoma; the diagnosis can only be based on clinical manifestations and imaging examination but also combined with patient history, tumor markers and biochemical examination. However, the final diagnosis depends on pathological biopsy.
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Gd-EOB-DTPA-enhanced MRI Image Characteristics and Radiomics Characteristics Combined with Machine Learning for Assessment of Functional Liver Reserve
Authors: Xin-Yu Zhu, Yu-Rou Zhang and Li GuoObjective:To investigate the feasibility of image characteristics and radiomics combined with machine learning based on Gd-EOB-DTPA-enhanced MRI for functional liver reserve assessment in cirrhotic patients.
Materials and Methods123 patients with cirrhosis were retrospectively analyzed; all our patients underwent pre-contrast MRI, triphasic (arterial phase, venous phase, equilibrium phase) Gd-EOB-DTPA dynamic enhancement and hepatobiliary phase (20 minutes delayed). The relative enhancement (RE) of the patient's liver, the liver-spleen signal ratio in the hepatobiliary phase (SI liver/ spleen), the liver-vertical muscle signal ratio in the hepatobiliary phase (SI liver/ muscle), the bile duct signal intensity contrast ratio (SIR), and the radiomics features were evaluated. The support vector machine (SVM) was used as the core of machine learning to construct the liver function classification model using image and radiomics characteristics, respectively.
Results:The area under the curve was the largest in SIR to identify Child-Pugh group A versus Child-Pugh group B+C in the image characteristics, AUC = 0.740, and Perc. 10% to identify Child-Pugh group A versus Child-Pugh group B+C in the radiomics characteristics, AUC = 0.9337. The efficacy of the SVM model constructed using radiomics characteristics was better, with an area under the curve of 0.918, a sensitivity of 95.45%, a specificity of 80.00%, and an accuracy of 89.19%.
Conclusion:The image and radiomics characteristics based on Gd-EOB-DTPA-enhanced MRI can reflect liver function, and the model constructed based on radiomics characteristics combined with machine learning methods can better assess functional liver reserve.
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Application of Artificial Intelligence (AI) System in Opportunistic Screening and Diagnostic Population in a Middle-income Nation
More LessObjectiveThis study evaluates the effectiveness of artificial intelligence (AI) in mammography in a diverse population from a middle-income nation and compares it to traditional methods.
MethodsA retrospective study was conducted on 543 mammograms of 467 Malays, 48 Chinese, and 28 Indians in a middle-income nation. Three breast radiologists interpreted the examinations independently in two reading sessions (with and without AI support). Breast density and BI-RADS categories were assessed, comparing the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) results.
ResultsOf 543 mammograms, 69.2% had lesions detected. Biopsies were performed on 25%(n=136), with 66(48.5%) benign and 70(51.5%) malignant. Substantial agreement in density assessment between the radiologist and AI software (κ =0.606, p < 0.001) and the BI-RADS category with and without AI (κ =0.74, p < 0.001). The performance of the AI software was comparable to the traditional methods. The sensitivity, specificity, PPV, and NPV or radiologists alone, radiologist + AI, and AI alone were 81.9%,90.4%,56.0%, and 97.1%; 81.0%, 93.1%,55.5%, and 97.0%; and 90.0%,76.5%,36.2%, and 98.1%, respectively. AI software enhances the accuracy of lesion diagnosis and reduces unnecessary biopsies, particularly for BI-RADS 4 lesions. The AI software results for synthetic were almost similar to the original 2D mammography, with AUC of 0.925 and 0.871, respectively.
ConclusionAI software may assist in the accurate diagnosis of breast lesions, enhancing the efficiency of breast lesion diagnosis in a mixed population of opportunistic screening and diagnostic patients.
Key Messages• The use of artificial intelligence (AI) in mammography for population-based breast cancer screening has been validated in high-income nations, with reported improved diagnostic performance. Our study evaluated the usage of an AI tool in an opportunistic screening setting in a multi-ethnic and middle-income nation.
• The application of AI in mammography enhances diagnostic accuracy, potentially leading to reduced unnecessary biopsies.
• AI integration into the workflow did not disrupt the performance of trained breast radiologists, as there is a substantial inter-reader agreement for BI-RADS category assessment and breast density.
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Early Clinical Efficacy of Small Incision Reduction and Superior Closed Pin Fixation of Goss-Ideberg Type III Glenoid Fractures using X-ray and CT Scan
Authors: Ying Zhang and Zhaorui LiuBackgroundImaging techniques such as X-rays and 3D Computed Tomography (CT) are used to diagnose and evaluate a patient's shoulder before and after surgery. Identifying the kind, location, and severity of a shoulder fracture helps surgeons choose the right treatment and surgery.
ObjectivesThe study examines the effectiveness of small incision reduction and superior closure pinning in treating Ideberg type III glenoid fractures identified by X-ray and CT scans.
Materials and MethodsFrom October 2017 to June 2022, 40 patients with Ideberg type III glenoid fractures underwent mini-incision reduction and superior closed pinning fixation using the Anterior (AA) and Posterior (PA) approaches. Pre- and post-surgery shoulder scores and imaging data were analyzed. Outpatient review and shoulder anteroposterior radiographs were collected at 1, 3, 6, and 12 months after surgery. We assessed shoulder joint function using the American Shoulder and Elbow Society (ASES) shoulder score, VAS score, Constant-Murley Shoulder Outcome (Constant) score, and DASH score.
ResultsA total of 40 patients were monitored for 14-16 months, averaging 15.2 ± 0.3 months. All fractures were healed between 14-25 weeks from X-rays, averaging 17.6 ± 5.4 weeks. Both the AA and PA groups had similar shoulder score changes. However, the AA group did better. In all cases, ASES shoulder scores were outstanding at 80%. Radiographs demonstratedno traumatic arthritis or internal fixation failure consequences like screw loosening or breakage.
ConclusionIt was concluded that Ideberg type III glenoid fracture reduction with an anterior small incision and superior closed pinning hollow lag screw internal fixation could be successful.
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Clinical Application of Automatic Assessment of Scoliosis Cobb Angle Based on Deep Learning
Authors: Lixin Ni, Zhehao Zhang, Lulin Zou, Jianhua Wang, Lijun Guo, Wei Qian, Lei Xu, Kaiwei Xu and Yingqing ZengIntroductionA recently developed deep-learning-based automatic evaluation model provides reliable and efficient Cobb angle measurements for scoliosis diagnosis. However, few studies have explored its clinical application, and external validation is lacking. Therefore, this study aimed to explore the value of automated assessment models in clinical practice by comparing deep-learning models with manual measurement methods.
MethodsThe 481 spine radiographs from an open-source dataset were divided into training and validation sets, and 119 spine radiographs from a private dataset were used as the test set. The mean Cobb angle values assessed by three physicians in the hospital's PACS system served as the reference standard. The results of Seg4Reg, VFLDN, and manual measurement were statistically analyzed. The intra-class correlation coefficients (ICC) and the Pearson correlation coefficient (PCC) were used to compare their reliability and correlation. The Bland-Altman method was used to compare their agreement. The Kappa statistic was used to compare the consistency of Cobb angles at different severity levels.
ResultsThe mean Cobb angle values measured were 35.89° ± 9.33° with Seg4Reg, 31.54° ± 9.78° with VFLDN, and 32.23° ± 9.28° with manual measurement. The ICCs for the reliability of Seg4Reg and VFLDN were 0.809 and 0.974, respectively. The PCC and MAD between Seg4Reg and manual measurements were 0.731 (p<0.001) and 6.51°, while those between VFLDN and manual measurements were 0.952 (p<0.001) and 2.36°. The Kappa statistic indicated VFLDN (k= 0.686, p< 0.001) was superior to Seg4Reg and manual measurements for Cobb angle severity classification.
ConclusionThe deep-learning-based automatic scoliosis Cobb angle assessment model is feasible in clinical practice. Specifically, the keypoint-based VFLDN is more valuable in actual clinical work with higher accuracy, transparency, and interpretability.
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Impact of 68Ga-PSMA PET/CT on Survival and Management in Prostate Cancer
Authors: Efnan Algın, Berna Okudan, Yusuf Açıkgöz, Haluk Sayan, Öznur Bal and Bedri SevenBackground68Ga-labeled prostate-specific membrane antigen positron emission tomography-computed tomography (68Ga-PSMA PET/CT) has led to altered treatment plans for prostate cancer (PCa) patients.
ObjectiveThis study aimed to investigate the impact of 68Ga-PSMA PET/CT on overall survival (OS) and management in PCa.
MethodsConsecutive 100 patients who had 68Ga-PSMA PET/CT and conventional imaging (CI) were included in this retrospective study. Disease stages and treatment plans according to both CI and 68Ga-PSMA PET/CT were compared. The effect of 68Ga-PSMA PET/CT on OS was assessed.
ResultsAfter 68Ga-PSMA PET/CT, the stage changed in 64 patients (64%). By the reason of 68Ga-PSMA PET/CT findings, treatment plans based on CI were changed in 73 patients (73%). According to the ROC analysis, patients with a PSA value below 8 had higher rates of change in staging (p<0.0001) and treatment (p=0.034). Both a PSA below 8 (OR 8.79 95% CI (2.72-28.43), p<0.001), and having a hormone-sensitive disease at the time of imaging (OR 5.6 95% CI (1.35-23.08), p=0.017) were significant independent factors predicting change in staging with 68Ga-PSMA PET/CT. The results of a phi correlation coefficient analysis showed a significant relationship between therapy and changes in staging (ϕ=0.638, p<0.0001). Two-year OS was statistically different in hormone-sensitive patients with and without treatment change (95% vs 81%, p=0.006).
Conclusion68Ga-PSMA PET/CT has the effect of changing the treatment in 73% of PCa patients. There is a positive correlation between the changes in staging and treatment. Survival of hormone sensitive patients has improved due to treatment changes based on PET/CT findings.
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MRI Insights in Breast Imaging
In the world, breast cancer is the most commonly diagnosed cancer among women. Currently, MRI is the most sensitive breast imaging method for detecting breast cancer, although false positive rates are still an issue. To date, the accuracy of breast MRI is widely recognized across various clinical scenarios, in particular, staging of known cancer, screening for breast cancer in high-risk women, and evaluation of response to neoadjuvant chemotherapy. Since technical development and further clinical indications have expanded over recent years, dedicated breast radiologists need to constantly update their knowledge and expertise to remain confident and maintain high levels of diagnostic performance in breast MRI. This review aims to detail current and future applications of breast MRI, from technological requirements and advances to new multiparametric and abbreviated protocols, and ultrafast imaging, as well as current and future indications.
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The Evolution of Medical Imaging in the Therapeutics of Patients with Skin Cancer
Authors: Khushmeen Kaur Brar, Jeba Shiney O, Bhawna Goyal and Ayush DograIntroductionMedical imaging mechanization has reformed medical management, empowering doctors to recognize cancer prematurely and promote patient outcomes. Imaging tests are of significant influence in the detection and supervision of cancer patients. Cancer recognition generally necessitates imaging studies that, in most instances, utilize a trivial amount of radiation. Methodologies such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) are predominant in clinical managerial, incorporating remedy and research.
BackgroundOver recent years, diagnostic imaging has progressed from a state of commencement to an advanced level. Numerous modern imaging procedures have evolved. Although contemporary medical imaging comprises image exhibition together with image refining, computer-aided diagnosis (CAD), image inscribing and conserving, and image transference, the majority of which are embraced in picture documentation and communication processes.
AimThis review targets to encapsulate toxicology information on skin cancer unpredictability essential to interpretation measures, report important factor that helps in defining skin cancer condition, and possible medical care alternatives or medical attention endorsed referring to diverse aspects involving the size and site of malignancy, the complications, patient’s priority and well being. We concisely review various therapy alternatives, methods of radiation autoimmunity, prime observational study designs of medical and distinct radiation resources and cancer risks, and current analysis methodologies and research precision.
ConclusionThe detail of this paper covers a brief review of research and evolution in medical imaging discipline and mechanism. This review considers the physiology of melanocytes and the pathogenesis of skin cancer using medical imaging. Also, a description of risk factors, prevention methods, screening, various diagnosis methods and different stages of skin cancer, sub-types and different types of treatment methods is provided in this paper for research and development.
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4D Flow MRI of Portal Vein Hemodynamics in Healthy Volunteers and Patients with Chronic Liver Disease
Authors: Mengmeng Zhang, Hailong Yu, Di Zhao, Wen Shen, Xu Bai, Meng Zheng, Jiachen Ji, Rui Li, Jianming Cai, Jinghui Dong and Changchun LiuAimTo identify age-matched healthy volunteers, non-cirrhotic chronic liver disease (CLD) and cirrhotic patients based on portal hemodynamic parameters using 4D flow MRI.
MethodsA total of 10 age-matched healthy volunteers and 69 CLD patients were enrolled and underwent 4D flow MRI prospectively. 4D flow MR images were processed by an MD in biomedical engineering working on the GTFlow platform. Portal hemodynamic parameters include net flow (mL/cycle), flow volume per second through the lumen (mL/sec), average flow velocity (cm/sec), and maximum flow velocity (cm/sec). The difference in portal hemodynamic parameters of 4D flow MRI was compared among healthy volunteers, non-cirrhotic CLD patients and patients with cirrhosis by one-way ANOVA or Kruskal-Wallis nonparametric test and post hoc tests.
Results10 CLD patients without cirrhosis and 56 patients with cirrhosis were eventually included, along with 10 healthy volunteers who were divided into three groups. 3 patients with cirrhosis whose image quality did not meet the requirements were excluded. There were no significant differences in portal hemodynamic parameters among the three groups except portal average velocity (P > 0.05). There was no statistical difference in all portal hemodynamic parameters of 4D flow MRI between healthy volunteers and patients with cirrhosis (P > 0.05). There were significant differences in portal average velocity between non-cirrhotic CLD patients, healthy volunteers and patients with cirrhosis, respectively (11.44±3.93 vs 8.10±2.66, P=0.013; 11.44±3.93 vs 8.60±2.22, P=0.007).
ConclusionPortal average velocity obtained by 4D flow MRI can be an auxiliary means to identify cirrhosis in patients with CLD.
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Choosing the Adaptive Cardiac Phase for Assessing Cardiac Dimensions Using Cardiac Computed Tomography for Heart Disease
Authors: Li Wang, Jin-Rong Zhou, Dong Chen, Yu-Jiao Deng and Jing ChenBackgroundCardiac chamber dimensions and left ventricle (LV) wall thickness change with the cardiac cycle, in which researchers have set different time points for systole and diastole.
ObjectiveThis study aimed to provide characteristics of normal heart and choose the correct cardiac cycle to measure maximum cardiac parameters for cardiovascular disease.
MethodsThe parameters of left atrium (LA), LV, right atrium (RA), and right ventricle (RV), as well as the wall thickness of LV, were measured in different cardiac phases using cardiac computed tomography (CT). Then, their differences in different phases and the correlation between these parameters and traditional risk factors were analyzed. In addition, receiver operator characteristic curve (ROC) analyses was performed to estimate LA enlargement.
ResultsThe dimensions of LA and RA as well as the wall thickness of LV reached the maximum at the phase of 35% – 45%, while the dimensions of LV and RV reached the maximum at 95% – 5%. However, the changes of LA-B (antero-posterior diameter), LV-D1 (basal dimension), RA-B (minor dimension), and RV-D2 (mid cavity dimension) were relatively more stable than other diameters during the cardiac cycle. The maximum LA-B diameter, LV-D1 diameter, RA-B diameter, and RV-D2 diameter as well as the maximum interventricular septum thickness were acquired. Heart rate (HR) and smoking were potential indicators of LV-D2 (mid cavity dimension), while HR and LV myocardial mass were potential indicators of LV-D3 (apical-basal dimension). In phase 45%, the cut-off value of LA-B was 37.12 mm, with high sensitivity for predicting LA enlargement.
ConclusionChoosing the adaptive cardiac phase for evaluating cardiac chamber dimensions and wall thickness obtained by cardiac CT could provide a more accurate clinical measurement of the heart.
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Ultrasonic Diagnosis of Congenital Enterocolitis Fistula: A Case Report
Authors: Zhiheng Yan, Bin Ma, Yalu Pang, Tiangang Li, Yixuan Wang and Fang NieBackgroundCongenital enterocolic fistula, an abnormal connection between the small intestine and the colon, is a rare condition with the potential for significant complications affecting the patient’s quality of life.
Case ReportA 2 year and 7 months old girl presented with abdominal pain and diarrhea lasting more than 10 days. The formation of the intestinal fistula was first detected by ultrasound, and the blood flow in the intestinal wall was preliminally analyzed. Surgical exploration revealed a colonic fistula formed by the attachment of the jejunum to the descending colon. Postoperatively, symptoms improved; no secondary infection occurred and the fistula healed well.
ConclusionCongenital colon fistula is rarely reported, and ultrasound is becoming more and more important in its diagnosis. Here, we report a case of congenital colonic fistula diagnosed by ultrasound. Ultrasound can dynamically and in real-time observe the intestinal condition, which is conducive to the early diagnosis and staging of congenital intestinal diseases and the determination of diagnosis and treatment schemes.
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Role of Multi-parameter-based Cardiac Magnetic Resonance in the Evaluation of Patients with Coronary Heart Disease Combined with Heart Failure
Authors: Ying Yu, Bihong Liao, Jingjing Zhang, Jin Zou, Jia Deng, Jiaqi Liu, Gang Wang, Yueyan Li, Fengcui Qian, Hong Huang, Qiuyu Wang, Jinwei Tian and Huifang TangBackgroundCoronary Heart Disease (CHD) is one of the most common types of cardiovascular disease, and Heart Failure (HF) is an important factor in its progression. We aimed to evaluate the diagnostic value and predictors of multiparametric Cardiac Magnetic Resonance (CMR) in CHD patients with HF.
MethodsThe study retrospectively included 145 CHD patients who were classified into CHD (HF+) (n = 91) and CHD (HF–) (n = 54) groups according to whether HF occurred. CMR assessed LV function, myocardial strain and T1 mapping. Multivariate linear regression analyses were performed to identify predictors of LV dysfunction, myocardial fibrosis, and LV remodeling.
ResultsCHD (HF+) group had impaired strain, with increased native T1, ECV, and LVM index. The impaired strain was associated with LVM index (p < 0.05), where native T1 and ECV were affected by log-transformed amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. ROC analysis showed the combination of global circumferential strain (GCS), native T1, and LVM had a higher diagnostic value for the occurrence of HF in CHD patients.
Meanwhile, log-transformed NT-proBNP was an independent determinant of impaired strain, increased LVM index, native T1 and ECV.
ConclusionHF has harmful effects on LV systolic function in patients with CHD. In CHD (HF+) group, LV dysfunction is strongly correlated with the degree of LV remodeling and myocardial fibrosis. The combination of the three is more valuable in diagnosing HF than conventional indicators.
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Radiomic Analysis of Contrast-Enhanced CT Predicts Glypican 3-Positive Hepatocellular Carcinoma
Authors: Shifang Sun, Shungen Xiao, Zhen Jiang, Junfeng Xiao, Qi He, Mei Wang and Yanfen FanBackgroundThe Glypican 3 (GPC3)-positive expression in Hepatocellular Carcinoma (HCC) is associated with a worse prognosis. Moreover, GPC3 has emerged as an immunotherapeutic target in advanced unresectable HCC systemic therapy. It is significant to diagnose GPC3-positive HCCs before therapy. Regarding imaging diagnosis of HCC, dynamic contrast-enhanced CT is more common than MRI in many regions.
ObjectiveThe aim of this study was to construct and validate a radiomics model based on contrast-enhanced CT to predict the GPC3 expression in HCC.
MethodsThis retrospective study included 141 (training cohort: n = 100; validation cohort: n = 41) pathologically confirmed HCC patients. Radiomics features were extracted from the Artery Phase (AP) images of contrast-enhanced CT. Logistic regression with the Least Absolute Shrinkage and Selection Operator (LASSO) regularization was used to select features to construct radiomics score (Rad-score). A final combined model, including the Rad-score of the selected features and clinical risk factors, was established. Receiver Operating Characteristic (ROC) curve analysis, Delong test, and Decision Curve Analysis (DCA) were used to assess the predictive performance of the clinical and radiomics models.
Results5 features were selected to construct the AP radiomics model of contrast-enhanced CT. The radiomics model of AP from contrast-enhanced CT was superior to the clinical model of AFP in training cohorts (P < 0.001), but not superior to the clinical model in validation cohorts (P = 0.151). The combined model (AUC = 0.867 vs. 0.895), including AP Rad-score and serum Alpha-Fetoprotein (AFP) levels, improved the predictive performance more than the AFP model (AUC = 0.651 vs. 0.718) in the training and validation cohorts. The combined model, with a higher decision curve indicating more net benefit, exhibited a better predictive performance than the AP radiomics model. DCA revealed that at a range threshold probability approximately above 60%, the combined model added more net benefit compared to the AP radiomics model of contrast-enhanced CT.
ConclusionA combined model including AP Rad-score and serum AFP levels based on contrast-enhanced CT could preoperatively predict GPC3-positive expression in HCC.
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A New Dıagnostic Tool for the Assessment of Pelvic Dysfunction in MR Defecography
Authors: Zafer Özmen and Fatma AktaşBackgroundPelvic floor dysfunction is characterized by incomplete fecal defecation, negatively affecting the quality of life. Magnetic resonance defecography (MRD) is a useful examination that is ionizing radiation-free and easily reproducible, and provides anatomical and functional details that are obtainable through multiplanar and dynamic examinations. The study aims to detect pathology using MRD in patients with suspected pelvic floor dysfunction and determine its cause.
MethodsMRD was performed on 79 individuals. Dynamic images were obtained at rest, straining, and during defecation. Pelvic hiatus mediolateral diameters were compared between groups.
ResultsThe defecation phase provided more accurate results than the straining phase for determining the existence and severity of pathology significantly.
ConclusionThe defecation phase is the most accurate phase for identifying the existence and severity of pathology, as the pelvic hiatus mediolateral diameter is thought to be an important factor in triggering pelvic dysfunction.
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Diffusion MRI in Intracranial Hypertension: Quantitative Assessment
Authors: Fatma Aktaş and Zafer ÖzmenPurposeIntracranial hypertension (IH) is a neurological disease characterized by increased intracranial pressure. Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure without an underlying neuroradiological cause (1-3). The IH associated with a reason such as a mass, hydrocephalus, or drug use, is referred to as secondary intracranial hypertension (SIH). We aimed to detect and determine whether the increased intracranial pressure causes a change in the diffusion values of the brain in the diffusion MRI images.
MethodsThe study includes 24 consecutive patients diagnosed with IIH and 18 consecutive patients diagnosed with secondary intracranial hypertension (SIH). The control group included 24 patients. Measurement of apparent diffusion coefficient (ADC) was performed using DWI sections obtained from subcortical white matter and the cortex of the frontal lobe in the basal ganglia plane, caudate nucleus head, thalamus, the posterior leg of the internal capsule, corpus callosum splenium; in the centrum semiovale plane, from the central white matter region. with 1.5T MRI using b=500s/mm2 and b=1000s/mm2 values both in patients and control groups. Mean ADC values were compared between IIH, SIH patients and control groups.
ResultsThe ADC values from the head of the caudate nucleus and the cortex were significantly higher in the IIH group compared to the control group. When the ADC values of the SIH and control groups were compared, it was found that some of the ADC measurements (subcortical white matter, cortex and semioval center) were significantly different. The comparison of the IIH and the SIH groups revealed that the ADC measurements of central white matter in the centrum semiovale, the subcortical white matter and the posterior leg of the internal capsule were significantly different.
ConclusionsWe have found increased diffusion of IIH and SIH patients, which supports the development of brain edema. Even though the mechanism of the brain edema in IIH is not entirely clear, it is thought that the mechanism is different from the brain edema caused by a mass or a sinus thrombosis.
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Hepatic Pecoma versus Hepatocellular Carcinoma In The Noncirrhotic Liver on Gd-EOB-DTPA-Enhanced MRI: A Diagnostic Challenge
Authors: Ruixia Ma, Shi-Ting Feng, Meicheng-Chen, Jifei Wang, Zhi Dong and Xiaoqi ZhouAimHepatic perivascular epithelioid cell tumors (PEComa) often mimic hepatocellular carcinoma (HCC) in patients without cirrhosis. This study aimed to develop a nomogram using imaging characteristics on Gd-EOB-DTPA-enhanced MRI and to distinguish PEComa from HCC in a non-cirrhotic liver.
MethodsForty patients with non-cirrhotic Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) were included in our study. A multivariate logistic regression model was used to select significant variables to distinguish PEComa from HCC. A nomogram was developed based on the regression model. The performance of the nomogram was assessed with respect to the ROC curve and calibration curve. Decision curve analysis (DCA) was performed to evaluate the clinical usefulness of the nomogram.
ResultsTwo significant predictors were identified: the appearance of an early draining vein and the T1D value of tumors. The ROC curve showed that the area under the curve (AUC) of the model to predict the risk of PEComa was 0.91 (95% CI: 0.80~1) and showed that the model had high specificity (92.3%) and sensitivity (88.9%). The nomogram incorporating these two predictors showed favorable calibration, which was validated using 1000 resampling procedures, and the corrected C-index of this model was 0.90. Furthermore, DCA analysis showed that the model had clinical practicability.
ConclusionIn conclusion, the nomogram model showed favorable predictive accuracy for distinguishing PEComa from HCC in non-cirrhotic patients and may aid in clinical decision-making.
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Unusual Breast Metastasis from Atypical Lung Carcinoid on 68Ga-DOTATATE PET/CT
Authors: Berna Okudan, Bedri Seven, Aslıhan Yıldırım and Aynur AlbayrakBackgroundAtypical carcinoid (AC) is one of the rarest lung neuroendocrine tumors (NETs) that rarely metastasize to the breast, and only a few cases have been reported in the literature. Positron emission tomography/computed tomography (PET/CT) with somatostatin analogs (SSAs) labeled with Gallium-68 (68Ga) now represents the gold standard for diagnosis and management of NETs. A case of an unusual metastasis to the breast from an AC detected by 68Ga-DOTATATE PET/CT was reported.
Case PresentationA 73-year-old woman was presented with a right breast lesion found on mammography screening, which revealed a metastatic neuroendocrine tumor by histopathological analysis with a tru-cut biopsy. Subsequently, 68Ga-DOTATATE PET/CT imaging performed for the initial evaluation showed increased radiotracer uptake in the lesion in the right breast as well as the nodular lesion in the middle lobe of the right lung, which was histologically confirmed to be AC.
ConclusionMetastasis of uncommon AC of the lung to the breast is extremely rare. However, it is essential to properly differentiate metastatic tumors from primary disease due to differences in clinical management and prognosis, and 68Ga-DOTATATE PET/CT is a unique diagnostic tool with the advantage of whole-body imaging.
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Microwave Imaging: Locating Bone Fractures using Patch Antenna of ISM Band
BackgroundThe human skeletal system relies heavily on the integrity of bones, which provide structural support and safeguard vital organs. Accurate detection is paramount for effective diagnosis. Conventional methods for identifying fractures manually are not only time-consuming but also susceptible to errors.
MethodsThe proposed methodology hinges on a patch antenna operating at 2.4 GHz and a bone phantom housing a simulated fracture, where the antenna is scanned. The collected signals are then processed with Delay-and-Sum (DAS), and Delay-Multiply-and-Sum (DMAS) reconstruction algorithms. The resulting images offer visual insights into the location of fractures.
ResultsThrough experimentation, the efficacy of the images varies considerably in terms of their capacity for noise and artifact suppression. While DAS exhibits reasonable effectiveness, it suppresses noise and artifacts comprehensively. In contrast, DMAS offers clearer and more precise images of bone fractures.
ConclusionIn summary, the research introduces a cost-effective and non-invasive strategy for detecting bone fractures. By involving a patch antenna at 2.4 GHz, along with image reconstruction algorithms like DMAS and DAS, one can effectively visualize the location of bone fractures. The experimental results highlight the superiority of DMAS over DAS in terms of contrast resolution, making it a highly promising avenue for fracture detection.
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Volumes & issues
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Volume 21 (2025)
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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)
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