Current Medical Imaging - Volume 20, Issue 1, 2024

Lemmel’s syndrome is defined as obstructive jaundice due to a PDD in the absence of choledocholithiasis or a neoplasm. The most common cause is the presence of PDD which arise within 2-3 cm from the ampulla of Vater. Currently, there are very few case reports of this condition, which was first named in 1934 after Dr. Gerhard Lemmel.

A 74-year-old female patient presented to the emergency department with complaints of abdominal pain and jaundice, and also had signs of pancreatitis, with laboratory results showing elevated liver and pancreatic enzymes and hyperbilirubinemia. We present a case of a patient who was diagnosed with Lemmel’s syndrome after abdominal CT, MRCP, and ERCP.

Although rare, it is imperative for physicians to recognize this syndrome in order to deliver prompt care. Because making the correct diagnosis in these patients is very important for correct treatment and preventing the development of complications.

Ultrasound-guided needle biopsies, including fine-needle aspirations (FNA) and core needle biopsies (CNB), have become an effective technique in the evaluation of thyroid nodules. In this report, we discuss the first reported case, to our knowledge, of thyroid pneumatosis after ultrasound-guided FNA.

A 44-year-old woman underwent ultrasound-guided FNA in other hospitals after thyroid ultrasound revealed a solid lesion in the left lobe classified as TI-RADS 4. Two days later, this female presented to our hospital for an excision of a thyroid mass. Pre- and post-contrast CT scans of the thyroid showed extensive accumulation of gas in the thyroid gland and the retropharyngeal and retrotracheal space. A CT scan of the thyroid two days later revealed obvious absorption of thyroid gas and faint low-density nodules in the left lobe of the thyroid. The lesion was histopathologically confirmed as papillary carcinoma of the thyroid.

We thought the aforementioned issues originating from the limited imaging capacity of ultrasound in the context of thyroid biopsy. To avoid these limitations, we highlight the need to thoroughly examine the location of a lesion prior to thyroid biopsy to understand in detail the relationship between the lesion and the adjacent tissues, especially the proximity of the lesion to the trachea, the occurrence of coughing during a biopsy (indicating puncture of the trachea) is what operators need to be aware of so that they can manage such cases. On the other hand, we recommend that pre-operative use of CT before thyroid biopsy and especially if CT is needed anyway later for nodules evaluation before surgery to ensure the CT image quality.

Sesamoids and accessory bones are generally small-sized and oval-shaped structures whose function and pathology are not fully elucidated. Despite their small size, sesamoid bones can directly or indirectly cause diagnostic problems. Sesamoid bones are less common in the elbow region and may need to be differentiated from a lot of diagnoses such as fractures, osteochondritis dissecans, calcific tendinitis, and synovial chondromatosis.

A 55-year-old female patient presented with right elbow pain. An oval mass was seen near the medial epicondyle on the radiograph. A dynamic ultrasound examination was performed to reveal the relationship between the bone mass and the surrounding tissues, especially the ulnar nerve. Due to the well-circumscribed mass, a diagnosis of os subepicondylare mediale, a rare sesamoid bone, was made in light of current literature.

When a bone mass is seen in patients presenting with elbow pain, it will be useful to know and consider the sesamoid bones. In addition, ultrasonography should be performed in addition to radiography for a localized sesamoid bone in the medial region and adjacent to the ulnar nerve. Thus, the relationship of the sesamoid bone with existing and potential complaints can be revealed and correct diagnosis-treatment approaches can be applied.

In clinical practice, Preoperative differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma is challenging but critical for treatment decisions.

This study investigated the discriminatory power of the stretched-exponential model and fractional-order calculus model parameters for hepatocellular carcinoma versus intrahepatic cholangiocarcinoma in orthotopic xenograft nude mice.

Prototype orthotopic xenograft models of hepatocellular carcinoma and intrahepatic cholangiocarcinoma were developed using 20 nude mice divided into two groups and separately transplanted with MHCC97H and HUCCT1 cells. Readout-segmented diffusion-weighted imaging with multiple b-values (0-2000 s/mm²) was obtained using a 3.0-T magnetic resonance imaging scanner. The apparent diffusion coefficient was calculated using the mono-exponential model. The distributed diffusion coefficient and intravoxel water molecular diffusion heterogeneity (α) were calculated using the stretched-exponential model. The diffusion coefficient (D), fractional-order derivative in space (β), and spatial parameter (μ) were calculated using the fractional-order calculus model. The liver and tumor specimens of nude mice were immunostained after euthanasia to clarify the liver cancer type. Differences in diffusion-related parameters between the groups were evaluated using Mann-Whitney U-test and univariate logistic analysis. Receiver operating characteristic curves were used to assess the diagnostic efficacy of each parameter. P<0.05 was deemed significant.

α, D, and β were significant discriminators between the groups. The area under the curve for these three variables was 0.890, 0.830, and 0.870, respectively, with cutoff values of 0.491, 0.435, and 0.782, respectively.

The stretched-exponential model parameters α and the fractional-order calculus model parameters D and β showed high diagnostic efficacy in discriminating intrahepatic cholangiocarcinoma from hepatocellular carcinoma in orthotopic xenograft nude mouse models.

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

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

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

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

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

Prostate magnetic resonance imaging (MRI) has been recently integrated into the pathway of diagnosis of prostate cancer (PCa). However, the lack of an optimal contrast-to-noise ratio hinders automatic recognition of suspicious lesions, thus developing a solution for proper delimitation of the tumour and separating it from the healthy parenchyma are extremely important.

As a solution to this unmet medical need, we aimed to develop a decision support system based on artificial intelligence, which automatically segments the prostate and any suspect area from the 3D MRI images.

We assessed retrospective data from all patients diagnosed with PCa by MRI-US fusion prostate biopsy, who underwent prostate MRI in our department due to a clinical or biochemical suspicion of PCa (n=33). All examinations were performed using a 1.5 Tesla MRI scanner. All images were reviewed by two radiologists, who performed manual segmentation of the prostate and all lesions. A total of 145 augmented datasets were generated. The performance of our fully automated end-to-end segmentation model based on a 3D UNet architecture and trained in two learning scenarios (on 14 or 28 patient datasets) was evaluated by two loss functions.

Our model had an accuracy of over 90% for automatic segmentation of prostate and PCa nodules, as compared to manual segmentation. We have shown low complexity networks, UNet architecture with less than five layers, as feasible and to show good performance for automatic 3D MRI image segmentation. A larger training dataset could further improve the results.

Therefore, herein, we propose a less complex network, a slim 3D UNet with superior performance, being faster than the original five-layer UNet architecture.

Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting inflammatory condition of unknown etiology that is characterized by fever and painful lymphadenopathy. KFD commonly involves the posterior cervical region and very rarely occurs in the axilla.

We report on a case of KFD that presented 3 weeks after receiving the messenger ribonucleic acid-based coronavirus disease 2019 (COVID-19) vaccine. In this case, we suspected the lesions as COVID-19 vaccination-related lymphadenopathy on the initial ultrasonographic examination.

Through this case report, we highlight that KFD should be considered in the differential diagnosis of patients with axillary lymphadenopathy who have undergone COVID-19 vaccination, as unusual side effects of COVID-19 vaccination have been increasingly reported in the literature owing to the rapid development of various COVID-19 vaccines during the pandemic period. In addition, we emphasize the importance of clinical suspicion in diagnosing KFD due to the fact that axillary involvement of KFD is extremely rare.

Cerebellopontine angle lipoma is a rare tumor that composes less than 1% of all CPA tumors. There has been no recorded case of unilateral CPA/IAC lipoma with sudden contralateral deafness yet.

We report a 52-year-old man diagnosed with right cerebellopontine angle lipoma and combined left total deafness. Pure-tone audiometry revealed total sensorineural deafness in his left ear and moderate sensorineural deafness in the right ear. The patient was treated with glucocorticoids, batroxobin, and other symptomatic treatments. There was no substantial improvement in hearing after 14 days’ treatment.

We chose conservative treatment for him. It is advised to wear hearing aids in the right ear and to undergo regular imaging monitoring.

Treatment options for such patients should be chosen by taking into account the degree of bilateral hearing loss, the size and location of the tumor, the possibility of preserving hearing during surgery, the functional level of the patient's facial nerve, and other factors.

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

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

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

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

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

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

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

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

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

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

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

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

Synthetic MRI can provide multiple contrast-weighted brain images with high resolution from a single scan via a 3D sequence using an interleaved Look-Locker acquisition sequence with a T2 preparation pulse (3D-QALAS).

This study aimed to assess the diagnostic image quality of 3D synthetic MRI using compressed sensing (CS) in clinical practice.

We retrospectively reviewed the imaging data of 47 patients who underwent brain MRI, including 3D synthetic MRI using CS in a single session, between December 2020 and February 2021. Two neuroradiologists independently evaluated the overall image quality, anatomic demarcation, and artifacts for synthetic 3D T1-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR), phase-sensitive inversion recovery (PSIR), and double inversion recovery images, using a 5-point Likert scale. The interobserver agreement between the two readers was assessed using percent agreement and weighted κ statistics.

The overall image quality of 3D synthetic T1WI and PSIR was good to excellent, with easy or excellent anatomic demarcation and mild or no visible artifact. However, other 3D synthetic MRI-derived images showed insufficient image quality and anatomic demarcation with marked CSF pulsation artifacts. In particular, 3D synthetic FLAIR showed high-signal artifacts on the brain surface.

3D synthetic MRI, at its current status, cannot completely replace conventional brain MRI in daily clinical practice. However, 3D synthetic MRI can achieve scan-time reduction using CS and parallel imaging and may be useful for motion-prone or pediatric patients requiring 3D images where time-efficiency is important.

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

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

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

The chest X-ray (CXR) remains a widely used examination in the evaluation of patients with fever, to diagnose or rule out pneumonia. Recently, a study by our group suggested that it has no diagnostic value in patients with fever without respiratory signs and/or symptoms.

The objective of this study is to validate the results of our previous study.

A retrospective study was conducted in two hospitals in the Netherlands.

All patients that were referred to the internal medicine emergency department between May 2018 and May 2019 with a suspected infection defined as fever (temperature ≥38°C) or hypothermia (temperature <36°C) or CRP ≥100µg/mL.

We defined our primary outcome as the number of newly diagnosed pneumonia by CXR in cases of suspected infection with no obvious site of infection and nor localizing symptoms or signs.

We included 1052 patients, of which 106 did not have respiratory signs or symptoms. In this group, none of the CXRs (95% CI 0-2.36%) showed an infiltrate. Combined with our previous study, 176 CXRs were performed in patients with no respiratory signs or symptoms. None (95% CI 0-1.42%) showed an infiltrate.

Our results confirm that a CXR has no diagnostic value in the workup of fever without localizing signs or symptoms.

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

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

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

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

To analyze the MRI findings of stage IA ovarian cancer.

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

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

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