<![CDATA[Current Medical Imaging (Volume 20 - Issue 1)]]> https://eurekaselect.com/journal/33 RSS Feed for Journals | BenthamScience EurekaSelect (+https://eurekaselect.com) 2024-03-28 <![CDATA[Current Medical Imaging (Volume 20 - Issue 1)]]> https://eurekaselect.com/journal/33 <![CDATA[T2 Black Synovitis in Musculoskeletal MRI: Disease Spectrum and Imaging Characteristics of Joint Diseases]]>https://eurekaselect.com/article/1322112024-03-28 <![CDATA[Endometriosis Reccurence – is Ultrasound the Solution?]]>https://eurekaselect.com/article/1306952024-03-28Background: Transvaginal and transabdominal ultrasonography has become a widely used investigative method in the diagnostic workup of endometriosis, as well as for the postoperative follow-up. The variety of lesions, the distorted anatomy caused by adhesions and the fibrosis process represent the main challenges of the ultrasound evaluation. Regarding the recurrence of endometriosis, the diagnostic criteria are being imprecise, being adjusted according to the development of ultrasound techniques.

Objective and Methods: To this study, extensive research has been performed interrogating PubMed, Embase and Web of Science databases to identify published research including patients with endometriosis who underwent surgery. Included patients had postoperative ultrasound investigations to detect evidence of endometriosis recurrence. The selected timeframe was 5 years. We conducted a literature review on ultrasound markers of endometriosis recurrence.

Results: In this analysis, 2023 patients from 9 studies were included. The recurrence rate detected was 17.26%. The postoperative treatment was different in the selected studies and they include the administration of progesterone, oral combined contraceptives, GnRh antagonists, aromatase inhibitors and intrauterine devices with prolonged release of progesterone.

Discussion: The recurrence rate is different in the selected studies as a result of the recurrence definition used by each author and the minimum dimension of the lesions, in case of the cystic pattern. Innovative techniques of differential diagnosis by ultrasound are proposed, one of them being the textural analysis performed by computer-aided diagnosis – CAD. In order to standardize the recommendations regarding imaging techniques, we propose an algorithm for following up with patients in the postoperative period.

Conclusion: The transabdominal or endovaginal ultrasound performed regularly represents a key factor to determine the recurrence of endometriosis in the postoperative period and the imaging reassessment is recommended to be performed at a 6-month interval.

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<![CDATA[Differentiation of Borderline Epithelial Ovarian Tumors from Benign and Malignant Epithelial Ovarian Tumors by MRI Scoring]]>https://eurekaselect.com/article/1323252024-03-28Introduction: The distinction between benign and borderline epithelial ovarian tumors is important because treatment and follow-up strategies differ.

Objective: We aimed to evaluate benign, borderline, and malignant epithelial ovarian tumors using MRI features and contributed to the preoperative evaluation.

Methods: MRIs of 81 patients (20 bilateral), including 31 benign, 27 borderline, and 23 malignant, who had pelvic imaging between 2013-2020, were evaluated retrospectively. The evaluation was made blindly to the pathology result by two radiologists with MRI scoring and features that we determined. MRI evaluation was performed with T1 TSE, T2 TSE, fat-suppressed T2 TSE, and before and after contrast T1 fat-suppressed and non-fat-suppressed TSE images. The numbers and findings obtained in scoring were evaluated by Chi-Square, ordinal logistic regression, and 2 and 3 category ROC analysis.

Results: The total score varied between 7 and 24. Among the three groups, a significant difference was found in terms of T1, T2 signal intensity (p <0.01), size (p = 0.055), solid area (p <0.001), septa number (p <0.05), ovarian parenchyma (p = 0.001), ascites (p <0.001), peritoneal involvement (p <0.001), laterality (p <0.001), contrast enhancement pattern (p <0.001). On the other hand, no significant difference was found in terms of wall thickness, lymph node involvement and endometrial thickness (p> 0.05). Cut-off values were found as 11.5 and 18.5 in the 3-category ROC analysis performed for the score (VUS: 0.8109). Patients with a score below 11.5 were classified as benign, those between 11.5-18.5 as borderline, and those over 18.5 as malignant.

Conclusion: The differentiation of borderline tumors from benign and malignant tumors by MRI scoring will contribute to the preoperative diagnosis.

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<![CDATA[Primary Thymic Mucinous Adenocarcinoma with Extensive Punctate and Amorphous Calcifications: A Case Report]]>https://eurekaselect.com/article/1323262024-03-28Background: Primary thymic mucinous adenocarcinoma is an extremely rare and aggressive tumor with poor prognosis. The tumor may present as a heterogeneous solid or cystic mass accompanied by calcifications. However, clinical and radiologic features of the tumor are not well known due to the rarity of the disease, which makes accurate diagnosis difficult.

Case Presentation: Here we present a rare case of primary thymic mucinous adenocarcinoma in the anterior mediastinum, including computed tomography (CT) and magnetic resonance imaging (MRI) findings. Chest computed tomography revealed a large anterior mediastinal mass with extensive calcifications with poor enhancement. MRI showed that anterior mediastinal mass showed intermediate signal intensity on T1-weighted images (T1WI), high SI on T2-weighted images (T2WI), and heterogeneous enhancement. Biopsy was performed and the anterior mediastinal tumor was diagnosed as thymic mucinous adenocarcinoma by histopathologic examination and immunohistochemical staining.

Conclusion: Thymic mucinous adenocarcinomas could be included in differential diagnoses of anterior mediastinal tumors showing extensive calcification, and common imaging findings of mucinous adenocarcinoma such as T2 high signal intensity and heterogeneous enhancement on MRI may be helpful to diagnose thymic mucinous adenocarcinoma.

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<![CDATA[Deep Learning-reconstructed Parallel Accelerated Imaging for Knee MRI]]>https://eurekaselect.com/article/1320422024-03-28Background: Deep learning (DL) can improve image quality by removing noise from accelerated MRI.

Objective: To compare the quality of various accelerated imaging applications in knee MRI with and without DL.

Methods: We analyzed 44 knee MRI scans from 38 adult patients using the DL-reconstructed parallel acquisition technique (PAT) between May 2021 and April 2022. The participants underwent sagittal fat-saturated T2-weighted turbo-spin-echo accelerated imaging without DL (PAT-2 [2-fold parallel accelerated imaging], PAT-3, and PAT-4) and with DL (DL with PAT-3 [PAT-3DL] and PAT-4 [PAT-4DL]). Two readers independently evaluated subjective image quality (diagnostic confidence of knee joint abnormalities, subjective noise and sharpness, and overall image quality) using a 4-point grading system (1-4, 4=best). Objective image quality was assessed based on noise (noise power) and sharpness (edge rise distance).

Results: The mean acquisition times for PAT-2, PAT-3, PAT-4, PAT-3DL, and PAT-4DL sequences were 2:55, 2:04, 1:33, 2:04, and 1:33 min, respectively. Regarding subjective image quality, PAT-3DL and PAT-4DL scored higher than PAT-2. Objectively, DL-reconstructed imaging had significantly lower noise than PAT-3 and PAT-4 (P <0.001), but the results were not significantly different from those for PAT-2 (P >0.988). Objective image sharpness did not differ significantly among the imaging combinations (P =0.470). The inter-reader reliability ranged from good to excellent (κ = 0.761–0.832).

Conclusion: PAT-4DL imaging in knee MRI exhibits similar subjective image quality, objective noise, and sharpness levels compared with conventional PAT-2 imaging, with an acquisition time reduction of 47%.

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<![CDATA[Prediction of Lumbar Pedicle Screw Loosening Using Hounsfield Units in Computed Tomography]]>https://eurekaselect.com/article/1312142024-03-28Introduction: One of the most common issues following pedicle screw fixation is pedicle screw loosening. There are, however, few trustworthy methods for predicting screw loosening. The goal of the current study was to identify an efficient technique for using preoperative CT scanning to predict screw loosening in older patients and to offer recommendations for preoperative surgical planning.

Methods: The current analysis included retrospectively all patients who underwent lumbar pedicle screw fixation for degenerative lumbar diseases in our department between January 2015 and January 2022. Hounsfield units were used to assess each vertebra's attenuation in a CT scan (HU). Postoperative X-ray testing identified screw loosening. Using IBMSPSS 24.00 software, one-way analysis of variance (ANOVA) and receiver operating characteristic (ROC) curve analysis were performed.

Results: Over a mean follow-up period of 28.4±11.5 (range 12-44 months) months, screw loosening was noted in 53 of 242 patients (136 male and 106 female, average age 58.7±7.3 years). Gender, BMI, smoking habits, and whether or not a patient had diabetes or spondylolisthesis were not shown to be significantly different among the patients (P>0.05). The difference between the average lumbar vertebral HU values in the screw-loosening group and the control group was significant (P<0.01) at 120.3±31.5HU and 138.6±37.6HU, respectively. The average HU value of L1-L4 exhibited an area under the curve (AUC) of 0.691 (95% CI: 0.614-0.784), according to ROC curve analysis. A HU cut-off value of 122 HU is a likely cut-off point to predict screw loosening with a sensitivity of 70% and a specificity of 58%.

Conclusion: The use of screw augmentation techniques can be decided using a prospective CT scan HU value-based prediction. An independent risk factor for screw loosening in an instrumented lumbar vertebra is a cutoff L1-L5 average HU value of 122 HU.

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<![CDATA[Increased Brain Iron Deposition in Episodic Migraine: A Pilot Voxel-based Quantitative Susceptibility Mapping]]>https://eurekaselect.com/article/1312152024-03-28Introduction: Although iron deposition has been identified as a significant migraine trigger, the key structures in episodic migraine (EM) remain unknown.

Objective: The aim of this study is to investigate cerebral iron deposition in EM using an advanced voxel-based quantitative susceptibility mapping (QSM).

Methods: A multi-echo gradient echo sequence MR was performed in 15 episodic migraine patients (EMs) and 27 normal control subjects (NCs). The reconstructed quantitative susceptibility mapping images and voxel-based analysis were performed over the entire brain. The susceptibility value of all brain regions with altered iron deposition was extracted, and the correlations between susceptibility value and clinical variables (including HAMA, HAMD, MoCA, VAS, MIDAS score, diseased duration, and headache frequency) were calculated.

Results: EM patients presented increased susceptibility value in the left putamen and bilateral substantia nigra (SN) compared with NC. There was no correlation between susceptibility value and the clinical variables.

Conclusion: Increased brain iron deposition in the extrapyramidal system may be a biomarker for migraine, and abnormal iron metabolism may be involved in the extrapyramidal mechanism. The QSM technique would be an optimal and simple tool for clinical practice and research in iron measurement.

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<![CDATA[Endometrial Adenofibroma in a Patient Receiving Toremifene: A Case Report]]>https://eurekaselect.com/article/1312182024-03-28Introduction: Adenofibroma is a rare benign Müllerian mixed tumor composed of epithelial and mesenchymal cells. This tumor may occasionally be associated with toremifene therapy which is used as an adjuvant drug for breast cancer.

Case Presentation: We describe a case of a 55-year-old woman with adenofibroma of the endometrium. This patient was receiving toremifene after surgery and neoadjuvant chemotherapy for breast cancer. She underwent a total abdominal hysterectomy and bilateral salpingectomy. There was no evidence of tumor residual or recurrence at 32 months of MRI follow-up.

Conclusion: In conclusion, we report a rare case of endometrial adenofibroma in a patient receiving toremifene. It must be borne in mind that long-term toremifene therapy may increase the frequency of endometrial neoplasms.

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<![CDATA[Analysis of the Imaging Features and Prognosis of Pulmonary Tuberculosis Complicated with Pulmonary Embolism]]>https://eurekaselect.com/article/1305722024-03-28Objective: This study aimed to explore the imaging characteristics of patients with pulmonary tuberculosis complicated with pulmonary embolism and analyze the prognosis of the condition, thereby reducing the mortality and misdiagnosis rate of complications in this type of pulmonary tuberculosis.

Methods: In this retrospective study, a total of 70 patients diagnosed with pulmonary embolism by computed tomography pulmonary angiography (CTPA) from January 2016 to May 2021 in Anhui Chest Hospital were included. Among them, 35 patients with pulmonary embolism combined with pulmonary tuberculosis were set as the study group, and the other 35 patients with pulmonary embolism only were set as the control group. The imaging findings of chest CT examination, the incidence of pulmonary hypertension, the level of N-terminal proto-B-type brain natriuretic peptide (NT-proBNP), and the prognosis of patients were compared between the two groups. The incidence of deep venous embolism was evaluated by ultrasonography of the lower extremity.

Results: In the study group, the median age of patients was 71 years, and the ratio of males to females was 2.5 to 1. In the control group, the median age was 66 years old, and the male-to-female ratio was 2.2 to 1. There were 16 cases (16/35, 45.71%) in the study group and 10 cases (10/35, 28.57%) in the control group with an increased level of NT-proBNP. Pulmonary hypertension occurred in 10 patients (10/35, 28.57%) in the study group and 7 patients (7/35, 20.00%) in the control group. Patients who lost follow-up included 5 in the study group (5/35, 14.29%) and 3 in the control group (3/35, 8.57%). There were 17 cases (17/35, 48.57%) in the study group and 3 cases (3/35, 8.57%) in the control group with pulmonary artery widening, and the difference was significant (P < 0.001). There were 13 deaths in the study group (13/35, 37.14%) and 1 death in the control group (1/35, 2.86%), and the difference was significant (P <0.001).

Conclusion: Special signs of pulmonary artery widening, pulmonary hypertension of varying degrees, and increased levels of NT-proBNP of varying degrees can be found in patients with pulmonary tuberculosis complicated with pulmonary embolism, and the three signs are positively correlated. The mortality of patients with pulmonary tuberculosis complicated with pulmonary embolism is significantly higher than that of patients with pulmonary embolism alone. Pulmonary tuberculosis and pulmonary embolism both occur in the ipsilateral lung, causing clinical symptoms to cover each other, thereby making diagnosis difficult.

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<![CDATA[Acute Pancreatitis Complicated by Thrombosis in the Right Brachiocephalic Veins and Superior Vena Cava: A Case Report]]>https://eurekaselect.com/article/1323272024-03-28Background: Acute pancreatitis (AP) is one of the most common digestive emergencies, and vascular complication is one of the primary reasons for death, with splanchnic venous thrombosis being the most common. Although extra-splanchnic venous thrombosis is rare, it carries the risk of life-threatening secondary pulmonary embolism.

Case Presentation: We have, herein, reported a case of AP complicated by rare brachiocephalic vein thrombosis and superior vena cava thrombosis. A 40 years old woman was diagnosed with severe AP for abdominal pain 21 days ago. The patient received symptomatic treatment, including acid suppression, enzyme suppression, lipid-lowering, fluid infusion, anti-infection, and continuous renal replacement therapy. The patient was discharged after symptomatic relief. Recently, the patient was admitted again for middle-upper abdominal pain and discomfort. On admission, her blood platelet, DDimer, fibrin degradation products (FDP), and triglyceride levels have been found to be increased; abdominal enhanced CT showed pancreatic necrosis and an accumulation of peripancreatic necrosis and fluid, while chest enhanced CT suggested thrombosis in the right brachiocephalic vein and superior vena cava. The patient, however, improved and was discharged after anticoagulation combined with insulin and trypsin inhibitors.

Conclusion: In diagnosing and treating AP, dynamic monitoring of D-dimer levels is necessary for the timely detection of the development of thrombotic complications.]]> <![CDATA[18 F-FDG PET/MRI of Primary Hepatic Malignancies: Differential Diagnosis and Histologic Grading]]>https://eurekaselect.com/article/1315822024-03-28Background: Distinguishing between IHCC and HCC is important because of their differences in treatment and prognosis. The hybrid Positron Emission Tomography/magnetic Resonance Imaging (PET/MRI) system has become more widely accessible, with oncological imaging becoming one of its most promising applications.

Objective: The objective of this study was to see how well 18F-fluorodeoxyglucose (18F-FDG) PET/MRI could be used for differential diagnosis and histologic grading of primary hepatic malignancies.

Methods: We retrospectively evaluated 64 patients (53 patients with HCC, 11 patients with IHCC) with histologically proven primary hepatic malignancies using 18F-FDG/MRI. The Apparent Diffusion Coefficient (ADC), Coefficient of Variance (CV) of the ADC, and standardized uptake value (SUV) were calculated.

Results: The mean SUVmax value was higher for IHCC (7.7 ± 3.4) than for HCC (5.2 ± 3.1) (p = 0.019). The area under the curve (AUC) was 0.737, an optimal 6.98 cut-off value providing 72% sensitivity and 79% specificity. The ADCcv value in IHCC was statistically significantly higher than in HCC (p=0.014). ADC mean values in HCCs were significantly higher in low-grade tumors than in high-grade tumors. The AUC value was 0.73, and the optimal cut-off point was 1.20x10-6 mm2/s, giving 62% sensitivity and 72% specificity. The SUVmax value was also found to be statistically significantly higher in the high-grade group. The ADCcv value in the HCC low-grade group was found to be lower than in the highgrade group (p=0.036).

Conclusion: 18F FDG PET/MRI is a novel imaging technique that can aid in the differentiation of primary hepatic neoplasms as well as tumor-grade estimation.

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<![CDATA[Evaluation of Main Lacrimal Gland through Shear-wave Ultrasound Elastography in Patients with Low Schirmer Value]]>https://eurekaselect.com/article/1323902024-03-28Objective: To compare main lacrimal gland values through shear-wave elastography (SWE) in patients with low Schirmer value and unspecified Sjögren's syndrome (SS) with healthy controls.

Materials and Methods: Admitted to the ophthalmology department with Schirmer value <10 mm, randomly selected 46 eyes of 46 patients evaluated for Sjögren's syndrome (SS) in the rheumatology department between December 2022 and April 2023 were classified as low Schirmer group (LSG). Randomly selected 48 eyes of 48 patients at a similar age with Schirmer value >10 mm were included as controls. Main lacrimal gland SWE measurements in LSG and control groups were recorded and compared as meter/second (m/sec).

Results: Mean SWE values of the main lacrimal gland were measured as 2.78 ± 0.66 m/sec and 2.26 ± 0.29 m/sec in LSG and controls. SWE measurements were significantly higher in LSG patients than in controls (p<0.001). No significant correlation was found in the analysis between the Schirmer and the main lacrimal gland SWE values in LSG patients (p=0.702, r=0.058). No significant correlation was also detected between the Schirmer and main lacrimal gland SWE values in controls (p=0.097, r=0.242). No significant relationship was also found between age, gender, body mass index (BMI), and SWE values (p=0.351, p=0.493, p=0.328, respectively).

Conclusion: Mean SWE value of the main lacrimal gland was determined as significantly higher in patients with aqueous lacrimal insufficiency without SS than in controls. We consider that SWE measurements may be an imaging method to support the diagnosis of aqueous lacrimal insufficiency and used in follow-ups of those with dry eye syndrome (DES) in the future.

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<![CDATA[A Novel Combined Model to Predict the Prognosis of COVID-19: Radiologicalmetabolic Scoring]]>https://eurekaselect.com/article/1316972024-03-28Aim: To investigate the performance of a novel radiological-metabolic scoring (RM-S) system to predict mortality and intensive care unit (ICU) requirements among COVID-19 patients and to compare performance with the chest computed-tomography severity-scoring (C-CT-SS). The RMS was created from scoring systems such as visual coronary-artery-calcification scoring (V-CAC-S), hepatic-steatosis scoring (HS-S) and pancreatic-steatosis scoring (PS-S).

Methods: Between May 2021 and January 2022, 397 patients with COVID-19 were included in this retrospective cohort study. All demographic, clinical and laboratory data and chest CT images of patients were retrospectively reviewed. RM-S, V-CAC-S, HS-S, PS-S and C-CT-SS scores were calculated, and their performance in predicting mortality and ICU requirement were evaluated by univariate and multivariable analyses.

Results: A total of 32 (8.1%) patients died, and 77 (19.4%) patients required ICU admission. Mortality and ICU admission were both associated with older age (p < 0.001). Sex distribution was similar in the deceased vs. survivor and ICU vs. non-ICU comparisons (p = 0.974 and p = 0.626, respectively). Multiple logistic regression revealed that mortality was independently associated with having a C-CT-SS score of ≥ 14 (p < 0.001) and severe RM-S category (p = 0.010), while ICU requirement was independently associated with having a C-CT-SS score of ≥ 14 (p < 0.001) and severe V-CAC-S category (p = 0.010).

Conclusion: RM-S, C-CT-SS, and V-CAC-S are useful tools that can be used to predict patients with poor prognoses for COVID-19. Long-term prospective follow-up of patients with high RM-S scores can be useful for predicting long COVID.

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<![CDATA[Application of Magnetic Resonance Diffusion Tensor Imaging in Diagnosis of Lumbosacral Nerve Root Compression]]>https://eurekaselect.com/article/1324692024-03-28Objective: The aim of this study was to assess the value of 3.0T magnetic resonance (MR) Diffusion tensor imaging (DTI) in the diagnosis of lumbosacral nerve root compression.

Methods: The radiology reports, and clinical records of 34 patients with nerve root compression caused by lumbar disc herniation or bulging and 21 healthy volunteers who had undergone magnetic resonance imaging (MRI) and DTI scan were retrospectively reviewed. The differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between compressed and non-compressed nerve roots from patients and the normal nerve roots from healthy volunteers were compared. Meanwhile, the nerve root fiber bundles were observed and analyzed.

Results: The average FA and ADC values of the compressed nerve roots were 0.254 ± 0.307 and 1.892 ± 0.346 10^-3mm2/s, respectively. The average FA and ADC values of the non-compressed nerve roots were 0.377 ± 0.659 and 1.353 ± 0.344 10^-3mm2/s, respectively. The FA value of compressed nerve roots was significantly lower than that of non-compressed nerve roots (P < 0.01). The ADC value of compressed nerve roots was significantly higher than that of non-compressed nerve roots. There were no significant differences between the left and right nerve roots of normal volunteers in FA and ADC values (P > 0.05). The nerve roots at different levels of L3-S1 had significantly different FA and ADC values (P < 0.01). Incomplete fiber bundles with extrusion deformation, displacement or partial defect were observed in the compressed nerve root fiber bundles. The real diagnosis of the clinical situation of the nerve can provide neuroscientists with an important computer tool to help them infer and understand the possible working mechanism from the experimental data of behavior and electrophysiology.

Conclusion: The compressed lumbosacral nerve roots can be accurately localized through 3.0T magnetic resonance DTI, which is instructive for accurate clinical diagnosis and preoperative localization.

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<![CDATA[Survey of Denoising, Segmentation and Classification of Pancreatic Cancer Imaging]]>https://eurekaselect.com/article/1317712024-03-28Background: Pancreatic cancer is one of the most serious problems that has taken many lives worldwide. The diagnostic procedure using the traditional approaches was manual by visually analyzing the large volumes of the dataset, making it time-consuming and prone to subjective errors. Hence the need for the computer-aided diagnosis system (CADs) emerged that comprises the machine and deep learning approaches for denoising, segmentation and classification of pancreatic cancer.

Introduction: There are different modalities used for the diagnosis of pancreatic cancer, such as Positron Emission Tomography/Computed Tomography (PET/CT), Magnetic Resonance Imaging (MRI), Multiparametric-MRI (Mp-MRI), Radiomics and Radio-genomics. Although these modalities gave remarkable results in diagnosis on the basis of different criteria. CT is the most commonly used modality that produces detailed and fine contrast images of internal organs of the body. However, it may also contain a certain amount of gaussian and rician noise that is necessary to be preprocessed before segmentation of the required region of interest (ROI) from the images and classification of cancer.

Methods: This paper analyzes different methodologies used for the complete diagnosis of pancreatic cancer, including the denoising, segmentation and classification, along with the challenges and future scope for the diagnosis of pancreatic cancer.

Results: Various filters are used for denoising and image smoothening and filters as gaussian scale mixture process, non-local means, median filter, adaptive filter and average filter have been used more for better results.

Conclusion: In terms of segmentation, atlas based region-growing method proved to give better results as compared to the state of the art whereas, for the classification, deep learning approaches outperformed other methodologies to classify the images as cancerous and non- cancerous. These methodologies have proved that CAD systems have become a better solution to the ongoing research proposals for the detection of pancreatic cancer worldwide.

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<![CDATA[A Comprehensive Review on MRI-based Knee Joint Segmentation and Analysis Techniques]]>https://eurekaselect.com/article/1317732024-03-28 <![CDATA[Establishing Protocol-based Dose Metrics for Common Abdomen and Pelvis Computed Tomography Protocols]]>https://eurekaselect.com/article/1319932024-03-28Background: The majority of the existing diagnostic reference levels (DRLs) that have been established for computed tomography (CT) are based on various anatomical locations, such as the head, chest, abdomen, etc. However, DRLs are initiated to improve radiation protection by conducting a comparison of similar examinations with similar objectives. The aim of this study was to explore the feasibility of establishing dose baselines based on common CT protocols for patients who underwent enhanced CT abdomen and pelvis exams.

Methods: Dose length product total (tDLPs), volumetric CT dose index (CTDIvol), size-specific dose estimate (SSDE), effective dose (E), and scan acquisition parameters for a total of 216 adult patients, who underwent an enhanced CT abdomen and pelvis exams over a one-year period, were obtained and retrospectively analyzed. Spearman coefficient and one-way ANOVA tests were used to check significant differences between dose metrics and the different CT protocols.

Results: The data exhibited 9 different CT protocols to acquire an enhanced CT abdomen and pelvis exam at our institute. Out of these, 4 were found more common, i.e., CT protocols were acquired for a minimum of 10 cases. Triphasic liver demonstrated the highest mean and median tDLPs across all 4 CT protocols. Triphasic liver protocol registered the highest E followed by gastric sleeve protocol with a mean of 28.7 and 24.7 mSv, respectively. Significant differences (p < 0.0001) were found between the tDLPs of anatomical location and the CT protocol.

Conclusion: Evidently, wide variability exists across CT dose indices and patient dose metrics relying on anatomical-based dose baseline, i.e., DRLs. Patient dose optimizations require establishing dose baselines based on CT protocols rather than the anatomical location.

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<![CDATA[Image Quality Improvement of Low-dose Abdominal CT using Deep Learning Image Reconstruction Compared with the Second Generation Iterative Reconstruction]]>https://eurekaselect.com/article/1320542024-03-28Background: Whether deep learning-based CT reconstruction could improve lesion conspicuity on abdominal CT when the radiation dose is reduced is controversial.

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

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

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

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

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

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<![CDATA[Sclerosing Angiomatoid Nodular Transformation of the Spleen: Radiological Findings and Radiological-pathological Correlation]]>https://eurekaselect.com/article/1312132024-03-28Introduction: The objective of this study was to describe the CT and MRI features of sclerosing angiomatoid nodular transformation (SANT) of the spleen with pathologic correlation.

Materials and Methods: Ten patients with surgically resected and pathologically confirmed SANTs were included. Clinical history was reviewed, and gross pathologic, histologic, and immunohistochemical findings were recorded. CT and MRI examinations were evaluated by two radiologists.

Results: Patients included seven men and three women, with a mean age of 42.9±16.7 years. Pathologic features of SANTs involved multiple angiomatous nodules in a radiating pattern with a central stellate fibrous scar and evidence of hemosiderin deposition. 9 cases showed a lobulated demarcated margin, 8 cases a slight hypoattenuating, 1 isoattenuating, and 1 case with two lesions demonstrated a slight hyperattenuating margin, respectively. Multiple scattered punctate calcifications were involved in 2 cases. 5 cases manifested hypointensity on in-phase imaging, 1 iso-intensity, and 4 iso-hypointensity on out-of-phase imaging. Progressive and centripetal enhancement were exhibited in 10 cases, spoke-wheel pattern in 3 cases, and nodular enhancement in 4 cases, respectively. The central fibrous scar was identified in 8 cases during delayed enhancement.

Conclusion: Characteristics of SANTs on CT/MRI reflected the underlying pathology. Hypointensity on DWI and T2WI, and change of signal on T1 chemicalshift imaging were found to be due to hemosiderin deposition and fibrous tissue. Typical feature was a solitary, round, lobulated mass with a fibrous scar. Progressive and centripetal enhancement, spoke-wheel pattern, nodular enhancement, and delayed enhancement of central fibrous scar were observed.

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<![CDATA[Does Morphology of the Shoulder Joint Play a Role in the Etiology of Rotator Cuff Tear?]]>https://eurekaselect.com/article/1312162024-03-28Background: The etiology of rotator cuff tears (RCTs) have been investigated for years and many underlying causes have been identified. Shoulder joint morphology is one of the extrinsic causes of RCTs.

Aim: Morphometric measurements on MRI sections determined which parameters are an important indicator of RCT in patients with shoulder pain. The aim of this study was to determine the risk factors in the etiology of RCTs by evaluating the shoulder joint morphology with the help of previously defined radiological parameters.

Methods: Between January 2019-December 2020, 408 patients (40-70 years old) who underwent shoulder MRI and met the criteria were included in the study. There were 202 patients in the RCT group and 206 patients in the control group. Acromion type, acromial index (AI), critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral acromial angle (LAA), acromial angulation (AA), acromion-greater tuberosity impingement index (ATI), and glenoid version angle (GVA) were measured from the MRI images of the patients.

Results: AI (0.64 vs. 0.60, p = 0.003) CSA (35.3° vs. 32.4°, p = 0.004), ATI (0.91 vs. 0.83, P < 0.001), and AA (13.6° vs. 11.9°, p = 0.011) values were higher in the RCT group than in the control group and the difference was significant. AHD (8.1 mm vs. 9.9 mm, P < 0.001), LAA (77.2° vs. 80.9°, p = 0.004) and GVA (-3.9° vs. -2.5°, P < 0.001) values were lower in the RCT group than in the control group, and again the difference was significant. According to the receiver operating characteristic curve analysis, the cutoff values were 0.623 for AI and 0.860 for ATI.

Conclusion: Acromion type, AI, CSA, AHD, LAA, AA, ATI, and GVA are suitable radiological parameters to evaluate shoulder joint morphology. High AI, CSA, AA, ATI, GVA and low AHD and LAA are risk factors for RCT.

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<![CDATA[The Comparison of Low and High-dose Scintigraphy findings in Patients with Primary Parathyroid Lesions in which Intraoperative Gamma-probe was Applied]]>https://eurekaselect.com/article/1312172024-03-28Objective: We aimed to evaluate the effectiveness of high-dose and low-dose use of radioactive material in intraoperative gamma probe application methods in patients diagnosed with primary hyperparathyroidism and planned for surgery.

Methods: 47 patients with primary hyperparathyroidism underwent minimally-invasive parathyroid surgery (MIS) after preoperative imaging studies consisting of ultrasonography (USG) and sestamibi parathyroid scintigraphy (SPS) showed a possible primary parathyroid lesion (PPL). All patients received Tc-99 sestamibi on day-of-surgery imaging (DOSI) to help with the localization of a primary parathyroid lesion (PPL) via both DOSI and intraoperative gamma probe (IGP). Patients in Group I were administered 20-25 mCi Tc-99m sestamibi (methoxy isobutyl isonitrile) and images were obtained at the 20th and 120th minutes. Patients in Group II were administered 8-10 mCi doses and images were obtained at the 20th and 40th minutes. Two nuclear medicine specialists independently evaluated the images. Lesions in the localizations determined by DOSI and IGP were compared with the histopathological results of these lesions.

Results: 47 patients, 35 females, and 12 males were included in the study. The mean age of 28 patients in the first group given the high dose was 54 (41-60), and the mean age was 48 (42-57) in the second group given the low dose (p=0.011). In the group given low-dose radioactive material during intraoperative gamma probe application, the observer's sensitivity, specificity, positive, and negative predictive values for finding pathology were 61.1, 100, 100, and 12.5, respectively. In the group given high-dose radioactive material, the same values were 90.9, 33.3, 50, and 83.3, respectively. While the success of MIS increases with the use of DOSI and IGP in large lesions, the success decreases with the prolongation of the accumulation time of the given dose.

Conclusion: In the intraoperative gamma probe technique used in primary hyperparathyroidism patients, the method used with low-dose radioactive material has lower sensitivity but higher specificity in estimating the post-operative pathology compared to the high-dose technique.

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<![CDATA[Classification of Brain Tumours in MRI Images using a Convolutional Neural Network]]>https://eurekaselect.com/article/1303652024-03-28Introduction: Recent advances in deep learning have aided the well-being business in Medical Imaging of numerous disorders like brain tumours, a serious malignancy caused by unregulated and aberrant cell portioning. The most frequent and widely used machine learning algorithm for visual learning and image identification is CNN.

Methods: In this article, the convolutional neural network (CNN) technique is used. Augmentation of data and processing of images is used to classify scan imagery of brain MRI as malignant or benign. The performance of the proposed CNN model is compared with pre-trained models: VGG-16, ResNet-50, and Inceptionv3 using the technique which is transfer learning.

Results: Even though the experiment was conducted on a relatively limited dataset, the experimental results reveal that the suggested scratched CNN model accuracy achieved is 94%, VGG-16 was extremely effective and had a very low complexity rate with an accuracy of 90%, whereas ResNet- 50 reached 86% and Inception v3 obtained 64% accuracy.

Conclusion: When compared to previous pre-trained models, the suggested model consumes significantly less processing resources and achieves significantly higher accuracy outcomes and a reduction in losses.

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<![CDATA[Efficacy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis of Mediastinal and Hilar Lesions]]>https://eurekaselect.com/article/1313252024-03-28Background: Mediastinal and hilar lesions may be benign or malignant. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is increasingly used for the diagnosis of these lesions as it is both minimally invasive and safe.

Objective: To investigate the clinical efficacy of EBUS-TBNA in the diagnosis and differential diagnosis of mediastinal and hilar lesions.

Methods: A retrospective observational study was undertaken to investigate patients diagnosed with mediastinal and hilar lymphadenopathy based on imaging at our hospital from 2020 to 2021. After evaluation, EBUS TBNA was used and data including the puncture site, postoperative pathology, and complications were recorded.

Results: Data from 137 patients were included in the study, of which 135 underwent successful EBUS TBNA. A total of 149 lymph node punctures were performed, of which 90 punctures identified malignant lesions. The most common malignancies were small-cell lung carcinoma, adenocarcinoma, and squamous cell carcinoma. Forty-one benign lesions were identified, resulting from sarcoidosis, tuberculosis, and reactive lymphadenitis, amongst others. Follow-up findings showed that 4 cases were malignant tumors, with 1 case of pulmonary tuberculosis and 1 case of sarcoidosis). Four specimens where lymph node puncture was insufficient were subsequently confirmed by other means. The sensitivity of EBUS TBNA for malignant lesions, tuberculosis and sarcoidosis in mediastinal and hilar lesions was 94.7%, 71.4%, and 93.3%, respectively. Similarly, the negative predictive values (NPV) were 88.9%, 98.5%, and 99.2%, and the accuracy was 96.3%, 98.5%, and 99.3%.

Conclusion: EBUS TBNA is an effective and feasible approach for the diagnosis of mediastinal and hilar lesions that is minimally invasive and safe.

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<![CDATA[Radiological Evaluation of Effectiveness of PCCP Fixation for Femoral Neck Fracture: Med-term Effectiveness in a Retrospective Multicenter]]>https://eurekaselect.com/article/1322542024-03-28Background: It has been reported in the literature that the complication rate of percutaneous compression plate (PCCP) is the lowest among the new internal fixators for the treatment of femoral neck fracture (FNS). However, no multicenter studies of PCCP for FNS have been reported. This study aimed to evaluate the med-term effectiveness of PCCP in a multicenter mainly through radiology.

Methods: 265 patients with FNF treated with PCCP fixation in our five hospitals between January 2011 and December 2020 were retrospectively analyzed. 140 men and 125 women; aged 19–79 (mean 51.6)years. The follow-up time was 2-5 years (mean 3.1). Radiological evaluation of the therapeutic effect was the main outcome, and the function was the secondary outcome.

Results: One case of screw cutting out, 3 cases of screw back out, 25 cases of neck shortening, 2 cases of nonunion, 8 cases of delayed healing, and 29 cases of avascular necrosis (AVN). Bivariate correlation showed that shortening healing was correlated with age, Singh index, and Garden alignment index, poor healing was correlated with garden alignment index, and AVN was correlated with Pauwels and Garden classifications and operation timing. Further pairwise comparison analysis showed that age of > 65 and Singh index IV were dangerous factors for neck shortening, and the operation timing > 3 days, Pauwels II and III, and Garden III and IV were dangerous factors for AVN. The excellent and good rate of function in 198 patients who were readmitted for internal fixator removal or other surgery was 90.9%.

Conclusion: PCCP for FNS has satisfactory med-term efficacy with a low complication rate. The main complication is AVN, which is prone to occur in patients with displaced Pauwels II or III FNF and operation timing > 3 days. Another main complication is shortening healing, which is prone to occur in patients with an age of > 65 and Singh index IV.

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<![CDATA[Recent Applications of Deconvolution Microscopy in Medicine]]>https://eurekaselect.com/article/1322552024-03-28 <![CDATA[Contrast-enhanced Ultrasound of Xanthogranulomatous Endometritis: A Case Report and Literature Review]]>https://eurekaselect.com/article/1317022024-03-28Introduction: Xanthogranulomatous endometritis (XGE) is a rare inflammatory disease, which can easily misdiagnose as cancer in imaging diagnosis. Diagnosis of XGE relies on histopathological examination and immunohistochemistry.

Case Presentation: In this study, a case of a 72-year-old female with XGE and elevated CA125 is presented, which was misdiagnosed as endometrial cancer in transvaginal ultrasonography and ovarian cystadenocarcinoma in CT. However, the features of XGE on the contrast-enhanced ultrasound (CEUS) were different from that of endometrial cancer. The patient finally underwent laparoscopic hysterectomy and bilateral adnexectomy.

Discussion: The histopathological examination and immunohistochemistry suggested xanthogranulomatous endometritis (histiocytic endometritis). This case report manifests that CEUS may be a new noninvasive diagnostic method for XGE, which may reduce extensive tissue sampling and unnecessary hysterectomies for patients.

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<![CDATA[Imaging Features and Risk Factors of Pancreatic Cystic Lesions Complicating Autoimmune Pancreatitis: A Retrospective Study]]>https://eurekaselect.com/article/1301292024-03-28Objective: This study aimed to explore the imaging features and risk factors of PCLs complicating AIP, and investigate its prognosis through continuous imaging follow-up. Patients and Methods:

Patients who were diagnosed with AIP from January 2014 to December 2020 in our hospital were recruited. We analyzed the CT and MRI features of PCLs complicating AIP, and investigated its prognosis through imaging follow-up. We also compared subjects with and without PCLs using clinical, laboratory, and imaging data; the related risk factors associated with PCLs were investigated in a multivariate logistic regression analysis.

Results: In this group, 16 patients had PCLs and 86 did not. A total of 43 PCLs larger than 5mm were found in 15 patients. Among these PCLs, 35 showed homogeneous signal (density); one, bleeding; three, linear separation; and four, small focal low signal on T2WI. Eight patients with 23 PCLs appeared for the follow-up after steroid treatment. Short-term follow-up showed that 11 PCLs disappeared, nine reduced, one unchanged and two enlarged. Of the 12 PCLs that did not disappear, 10 PCLs disappeared at long-term follow-up, except for two reduced PCLs were not re-examined. Logistic regression analysis showed that drinking history was an independent risk factor, age ≥ 65 years was an independent protective factor for PCLs complicating AIP.

Conclusion: The imaging features of PCLs complicating AIP are various, which can be single or multiple, most of them are homogeneous, and some lesions may be accompanied by hemorrhage, separation and necrosis. Age ≥ 65 years and avoiding drinking may help to reduce the occurrence of these lesions.

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<![CDATA[A Lightweight AMResNet Architecture with an Attention Mechanism for Diagnosing COVID-19]]>https://eurekaselect.com/article/1312112024-03-28Aims: COVID-19 has become a worldwide epidemic disease and a new challenge for all mankind. The potential advantages of chest X-ray images on COVID-19 were discovered. We proposed a lightweight and effective Convolution Neural Network framework based on chest X-ray images for the diagnosis of COVID-19, named AMResNet.

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

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

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

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

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

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<![CDATA[Clinical Characteristics and High-resolution Computed Tomography Findings of 805 Patients with Mild or Moderate Infection from SARS-CoV-2 Omicron Subvariant BA.2]]>https://eurekaselect.com/article/1312202024-03-28Background: COVID-19 is a global pandemic. Currently, the predominant strain is SARS-CoV-2 Omicron subvariant BA.2 in many countries. Understanding its infection characteristics can facilitate clinical management.

Objectives: This study aimed to characterize the clinical, laboratory, and high-resolution computed tomography (HRCT) findings in patients with mild or moderate infection from SARS-CoV-2 Omicron subvariant BA.2.

Methods: We performed a retrospective study on patients infected with SARS-CoV-2 Omicron subvariant BA.2 between April 4th and April 17th, 2022. The clinical characteristics, laboratory features, and HRCT images were reviewed.

Results: A total of 805 patients were included (411 males and 394 females, median age 33 years old). The infection was mild, moderate, severe, and asymptomatic in 490 (60.9%), 37 (4.6%), 0 (0.0%), and 278 (34.5%) patients, respectively. Notably, 186 (23.1%), 96 (11.9%), 265 (32.9%), 11 (3.4%), 7 (0.9%), and 398 (49.4%) patients had fever, cough, throat discomfort, stuffy or runny nose, fatigue, and no complaint, respectively. Furthermore, 162 (20.1%), 332 (41.2%), and 289 (35.9%) patients had decreased white blood cell counts, reduced lymphocytes, and elevated Creactive protein levels, respectively. HRCT revealed pneumonia in 53 (6.6%) patients. The majority of the lung involvements were ground-glass opacity (50, 94.3%) mostly in the subpleural area. The grade of lung injury was mainly mild (90.6%). Short-term follow-ups showed that most patients with pneumonia recovered.

Conclusion: Most patients with mild or moderate infection from SARS-CoV-2 Omicron subvariant BA.2 were adults, with fever and upper respiratory symptoms as the main clinical presentations. Lower respiratory infection was mild, with ground-glass opacity in the subpleural area as the main finding.

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<![CDATA[A Randomized Comparison of Transradial and Transfemoral Approach in Hepatic Arterial Infusion Chemotherapy]]>https://eurekaselect.com/article/1316992024-03-28Introduction: Hepatic arterial infusion chemotherapy (HAIC) has been popular for treating unresectable hepatocellular carcinoma (HCC). However, there are few reports comparing the transradial approach (TRA) and transfemoral approach (TFA) in HAIC.

Objective: This study aimed to compare the duration of the hepatic artery catheterization, fluoroscopy time (FT), radiation exposure, safety, and quality of life associated with the procedure in patients undergoing HAIC via TRA and TFA.

Methods: This prospective, single-center, randomized, controlled study included 120 patients with unresectable HCC undergoing HAIC procedures. Patients were randomly assigned to group A (n = 60, TRA-HAIC) or group B (n = 60, TFA-HAIC). The hepatic artery catheterization time, FT, entrance surface dose (ESD), dose area product (DAP), procedure-related complications, and quality of life associated with the procedure were assessed between the two groups. Independent-sample t-test and analysis of variance (ANOVA) were used to assess differences. Statistical significance was set at P < 0.05.

Results: HAIC procedures were successfully performed in both groups. The hepatic artery catheterization time (19.35 ± 5.84 vs. 18.93 ± 5.62 minutes, P = 0.837), FT (2.35 ± 2.23 vs. 2.25 ± 2.16 minutes, P = 0.901), ESD (259.32 ± 167.46 vs. 250.56 ± 170.58 mGy, P = 0.449), and DAP (125.37 ± 60.65 vs. 120.56 ± 64.33 Gy.cm3, P = 0.566) were comparable between the two groups. The incidence of artery occlusion (10.0% vs. 0%, P < 0.001) in the TRA group was significantly higher than that in the TFA group. TRA was associated with a statistically significant (P < 0.05) improvement in the quality of life.

Conclusion: TRA to HAIC was associated with greater improvement in the quality of life associated with the procedure compared with TFA. Both approaches to HAIC had similar efficiency, safety, radiation exposure, and procedure duration.

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<![CDATA[Analysis of COVID-19 CT Chest Image Classification using Dl4jMlp Classifier and Multilayer Perceptron in WEKA Environment]]>https://eurekaselect.com/article/1309852024-03-28Introduction: In recent years, various deep learning algorithms have exhibited remarkable performance in various data-rich applications, like health care, medical imaging, as well as in computer vision. COVID-19, which is a rapidly spreading virus, has affected people of all ages both socially and economically. Early detection of this virus is therefore important in order to prevent its further spread.

Methods: COVID-19 crisis has also galvanized researchers to adopt various machine learning as well as deep learning techniques in order to combat the pandemic. Lung images can be used in the diagnosis of COVID-19.

Results: In this paper, we have analysed the COVID-19 chest CT image classification efficiency using multilayer perceptron with different imaging filters, like edge histogram filter, colour histogram equalization filter, color-layout filter, and Garbo filter in the WEKA environment.

Conclusion: The performance of CT image classification has also been compared comprehensively with the deep learning classifier Dl4jMlp. It was observed that the multilayer perceptron with edge histogram filter outperformed other classifiers compared in this paper with 89.6% of correctly classified instances.

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<![CDATA[Automated Brain Tumour Detection and Classification using Deep Features and Bayesian Optimised Classifiers]]>https://eurekaselect.com/article/1303872024-03-28Purpose: Brain tumour detection and classification require trained radiologists for efficient diagnosis. The proposed work aims to build a Computer Aided Diagnosis (CAD) tool to automate brain tumour detection using Machine Learning (ML) and Deep Learning (DL) techniques.

Materials and Methods: Magnetic Resonance Image (MRI) collected from the publicly available Kaggle dataset is used for brain tumour detection and classification. Deep features extracted from the global pooling layer of Pretrained Resnet18 network are classified using 3 different ML Classifiers, such as Support vector Machine (SVM), K-Nearest Neighbour (KNN), and Decision Tree (DT). The above classifiers are further hyperparameter optimised using Bayesian Algorithm (BA) to enhance the performance. Fusion of features extracted from shallow and deep layers of the pretrained Resnet18 network followed by BA-optimised ML classifiers is further used to enhance the detection and classification performance. The confusion matrix derived from the classifier model is used to evaluate the system's performance. Evaluation metrics, such as accuracy, sensitivity, specificity, precision, F1 score, Balance Classification Rate (BCR), Mathews Correlation Coefficient (MCC) and Kappa Coefficient (Kp), are calculated.

Results: Maximum accuracy, sensitivity, specificity, precision, F1 score, BCR, MCC, and Kp of 99.11%, 98.99%, 99.22%, 99.09%, 99.09%, 99.10%, 98.21%, 98.21%, respectively, were obtained for detection using fusion of shallow and deep features of Resnet18 pretrained network classified by BA optimized SVM classifier. Feature fusion performs better for classification task with accuracy, sensitivity, specificity, precision, F1 score, BCR, MCC and Kp of 97.31%, 97.30%, 98.65%, 97.37%, 97.34%, 97.97%, 95.99%, 93.95%, respectively.

Conclusion: The proposed brain tumour detection and classification framework using deep feature extraction from Resnet 18 pretrained network in conjunction with feature fusion and optimised ML classifiers can improve the system performance. Henceforth, the proposed work can be used as an assistive tool to aid the radiologist in automated brain tumour analysis and treatment.

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<![CDATA[An Efficient Ensemble-based Machine Learning approach for Predicting Chronic Kidney Disease]]>https://eurekaselect.com/article/1315802024-03-28Background: Chronic kidney disease (CKD) is a long-term risk to one’s health that can result in kidney failure. CKD is one of today's most serious diseases, and early detection can aid in proper treatment. Machine learning techniques have proven to be reliable in the early medical diagnosis.

Objective: The paper aims to perform CKD prediction using machine learning classification approaches. The dataset used for the present study for detecting CKD was obtained from the machine learning repository at the University of California, Irvine (UCI).

Methods: In this study, twelve machine learning-based classification algorithms with full features were used. Since the CKD dataset had a class imbalance issue, the Synthetic Minority Over-Sampling technique (SMOTE) was used to alleviate the problem of class imbalance and review the performance based on machine learning classification models using the K fold cross-validation technique. The proposed work compares the results of twelve classifiers with and without the SMOTE technique, and then the top three classifiers with the highest accuracy, Support Vector Machine, Random Forest, and Adaptive Boosting classification algorithms were selected to use the ensemble technique to improve performance.

Results: The accuracy achieved using a stacking classifier as an ensemble technique with cross-validation is 99.5%.

Conclusion: The study provides an ensemble learning approach in which the top three best-performing classifiers in terms of cross-validation results are stacked in an ensemble model after balancing the dataset using SMOTE. This proposed technique could be applied to other diseases in the future, making disease detection less intrusive and cost-effective.

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<![CDATA[Conventional <i>versus</i> Aspiration-type Needles in CT-guided Biopsy for Chest Pathologies/Lesions: A Comparative Study]]>https://eurekaselect.com/article/1319102024-03-28Background: Larger sample volume can be obtained in one needle pass using an aspiration-type semi-automatic cutting biopsy needle (STARCUT® aspirationtype needle; TSK Laboratory, Tochigi, Japan) in comparison to the conventional semi-automatic cutting biopsy needle.

Objective: To evaluate and compare the safety and effectiveness of aspiration-type semi-automatic cutting biopsy needles and non-aspiration-type biopsy needles when performing computed tomography (CT)-guided core needle biopsies (CNBs).

Methods: A total of 106 patients underwent CT-guided CNB for chest lesions between June 2013 and March 2020 at our hospital. Non-aspiration-type cutting biopsy needles were used in 47 of these patients, while aspiration-type needles were used in the remaining 59 patients. All needles used were 18- or 20-gauge biopsy needles. Parameters, like forced expiratory volume in 1-second percent (FEV1.0%), the maximum size of the target lesion, puncture pathway distance in the lung, number of needle passes, procedure time, diagnostic accuracy, and incidence of complications, were measured. Comparisons were made between the needle-type groups.

Results: No significant difference was observed in terms of diagnostic accuracy. However, the procedure time was shorter and a lesser number of needle passes were required with the aspiration-type cutting biopsy needle compared to the non-aspiration-type needle. Pneumothorax and pulmonary hemorrhage were the complications encountered, however, their incidence was not significantly different between the two types of needles.

Conclusion: The aspiration-type semi-automatic cutting biopsy needle had similar diagnostic accuracy as the non-aspiration-type biopsy needle, with added advantages of a lesser number of needle passes and shorter procedure time.

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<![CDATA[Current Concepts of Pain Pathways: A Brief Review of Anatomy, Physiology, and Medical Imaging]]>https://eurekaselect.com/article/1319422024-03-28Background: Although the essential components of pain pathways have been identified, a thorough comprehension of the interactions necessary for creating focused treatments is still lacking. Such include more standardised methods for measuring pain in clinical and preclinical studies and more representative study populations.

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

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

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

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

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<![CDATA[Evaluation of Coronary Artery Diffuse Calcification Stenosis by Corrected Coronary Opacification Difference]]>https://eurekaselect.com/article/1319902024-03-28Objectives: The artifacts produced by calcification on coronary computed tomographic angiography (CCTA) have a great influence on the diagnosis of coronary stenosis. The purpose of this study is to investigate the value of corrected coronary opacification (CCO) difference in the diagnosis of stenosis in diffusely calcified coronary arteries (DCCAs).

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

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

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

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<![CDATA[Ultrasonographic Evaluation of Normal Liver, Spleen, and Kidney Dimensions in a Healthy Turkish Community of Over 18 Years Old]]>https://eurekaselect.com/article/1319922024-03-28Background/Aims: The dimensions of the liver, spleen, and kidneys either change in primary diseases related to these organs or in secondary diseases that indirectly affect them, such as diseases of the cardiovascular system. Therefore, we aimed to investigate the normal dimensions of the liver, kidneys, and spleen and their correlations with body mass index in healthy Turkish adults.

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

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

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

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<![CDATA[Atypical Cytotoxic Lesion and Hemorrhagic Involvement of the Corpus Callosum in Severe COVID-19 Infection]]>https://eurekaselect.com/article/1309352024-03-28Introduction/Background: The COVID-19 pandemic has resulted in a large number of deaths and has caused a significant increase in population morbidity. This viral infection has been associated with different neurological symptoms and complications that do not have a clear pathophysiological mechanism and exact implications for these patients.

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

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

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<![CDATA[Three Different Faces of Schwannoma in Pediatric Patients]]>https://eurekaselect.com/article/1309362024-03-28Background: Schwannomas arise from nerve sheaths of cranial, peripheral, and spinal nerve or nerve roots. Most intracranial schwannomas arise from the cranial nerves, predominantly the vestibulocochlear nerve. In addition to cranial nerve schwannomas, intraparenchymal schwannomas of the brain and intramedullary schwannomas of the spinal cord are extremely rare.

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

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

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<![CDATA[Non-functional Adrenocortical Carcinoma in the Wall of the Small Bowel]]>https://eurekaselect.com/article/1309782024-03-28Background: Extra-adrenal non-functional adrenocortical carcinoma (ACC)is an extremely rare tumor with only eight cases having been reported at different localizations.

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

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

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<![CDATA[Effectiveness of the Neuroimaging Techniques in the Recognition of Psychiatric Disorders: A Systematic Review and Meta-analysis of RCTs]]>https://eurekaselect.com/article/1321042024-03-28Background: Neuroimaging has helped us learn about the stages of brain development from infancy to maturity. Neuroimaging helps physicians diagnose mental illnesses and find novel treatments for them. It can distinguish depression from neurodegenerative diseases or brain tumors, and it can reveal structural defects that cause psychosis. Psychosis has been linked to lesions in the frontal or temporal lobes of the brain, as well as the thalamus and hypothalamus, which can be detected using a brain scan for mental illnesses. Neuroimaging uses quantitative and computational methods to explore the central nervous system. It can detect brain injuries and psychological illnesses. Thus, a systematic review and meta-analysis of randomized controlled trials using neuroimaging to detect psychiatric disorders assessed their efficacy and benefits.

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

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

Conclusion: The present meta-analysis strongly recommends the use of neuroimaging techniques for the detection of psychiatric disorders.]]> <![CDATA[Feasibility Study of Combining Wall Shear Stress and Elastography to Assess the Vascular Status of Carotid Artery]]>https://eurekaselect.com/article/1303662024-03-28Introduction: At present, early detection of the potential risk of atherosclerosis and prevention is of great significance to reduce the occurrence of stroke.

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

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

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

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

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<![CDATA[Disease Quantification of Liver Lymphoma in CT Images without Lesion Segmentation]]>https://eurekaselect.com/article/1321862024-03-28Aim: This study aimed to automatically implement liver disease quantification (DQ) in lymphoma using CT images without lesion segmentation.

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

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

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

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

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<![CDATA[18F-Fluorodeoxyglucose PET/CT and MRI Imaging Characteristics of Monomorphic Epitheliotropic Intestinal T-cell Lymphoma: A Case Report]]>https://eurekaselect.com/article/1322062024-03-28Background: Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare, rapidly progressive, primary intestinal T-cell lymphoma. The most common site of occurrence is on the small intestine. The prognosis of MEITL is extremely poor due to delayed diagnosis and lack of targeted therapy.

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

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

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<![CDATA[Infiltrating Metastatic Ductal Carcinoma Initially Presenting as Axillary Lymph Node Metastases Diagnosed with PET/CT and MRI: Case Report and Brief Review of Occult Breast Carcinoma]]>https://eurekaselect.com/article/1317702024-03-28Introduction: The concept of occult breast carcinoma (OBC) was first described in 1907 by Halsted, who described this type of breast cancer to arise from small, undetectable tumours in the breast that had already metastasized to the lymph nodes. Although the breast is the most likely site for the primary tumour, non-palpable breast cancer presenting as an axillary metastasis has been reported, but with a low frequency of less than 0.5% of all breast cancers. OBC represents a complex diagnostic and therapeutic dilemma. Considering its rarity, clinicopathological information is still limited.

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

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

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<![CDATA[A Survey on the Machine Learning Techniques for Automated Diagnosis from Ultrasound Images]]>https://eurekaselect.com/article/1321272024-03-28 <![CDATA[Standardization of Breast Dynamic Contrast-enhanced MRI Signal with Application to the Assessment of Background Parenchymal Enhancement Rate]]>https://eurekaselect.com/article/1300082024-03-28Background: There is currently no clinically accepted method for quantifying background parenchymal enhancement (BPE), though a sensitive method might allow individualized risk management based on the response to cancer-preventative hormonal therapy.

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

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

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

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

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<![CDATA[Application of Computed Tomography Perfusion Imaging-guided Mechanical Thrombectomy in Ischemic Stroke Patients with Large Vessel Occlusion beyond the Therapeutic Time Window]]>https://eurekaselect.com/article/1323892024-03-28Introduction: To explore the feasibility of applying computed tomography perfusion (CTP) imaging-guided mechanical thrombectomy in acute ischemic stroke patients with large vessel occlusion beyond the therapeutic time window.

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

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

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

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<![CDATA[Atypical Radiological Findings of Capillary Hemangioma in Right Atrium: A Case Report]]>https://eurekaselect.com/article/1308592024-03-28Background: Cardiac hemangiomas account for only 2.8% of primary cardiac tumors and are caused by the abnormal proliferation of endothelial cells and excess blood vessels. Typical radiological findings of cardiac hemangioma demonstrate intense contrast enhancement.

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

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

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<![CDATA[Coronary Cameral Fistula Disclosed by Echocardiography: A Case Report of Typical Findings and Literature Review]]>https://eurekaselect.com/article/1301572024-03-28Background: Coronary cameral fistula is a rare cardiovascular anomaly, and usually needs advanced image modalities, such as computerized tomography and/or angiography, to confirm its existence. A few reports in the literature have addressed the role of medical ultrasound in the diagnosis of this disease, without a comprehensive summary of all the valuable echocardiographic features in its diagnosis.

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

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

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<![CDATA[The Treatment of Congenital Recto-vestibular Fistula and Recto-perineal Fistula, and the Effects of the Megarectum on Defecation]]>https://eurekaselect.com/article/1301582024-03-28Objective: This study aims to discuss the treatment of congenital recto-vestibular fistula and recto-perineal fistula, and the effect of the megarectum on defecation.

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

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

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

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

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<![CDATA[Evaluation of the Frequency of Tentorial Hypoplasia and Accompanying Gyral Herniation using MRI]]>https://eurekaselect.com/article/1301592024-03-28Purpose: The cerebellar tentorium, the second-largest dural reflection in the brain, separates supratentorial and infratentorial structures. This study aimed to determine the frequency of tentorial hypoplasia (TH) and gyral herniation and their relationship with clinical findings.

Methods: The standard brain MRIs were examined retrospectively. The presence of TH and laterality were investigated. If hypoplasia was accompanied by a gyrus extending inferior to the line where the tentorium should be located, this was recorded as tentorial hypoplasia-herniated gyrus (TH-HG), while the cases with hypoplasia alone were noted as isolated TH. It was also determined which gyrus or gyri were herniated. The clinical findings of the patients were obtained, and the correlation between HG was explored.

Results: Standard brain MRIs of the 2051 patients were evaluated. Two hundred ten patients were excluded from the study due to different intracranial disorders, and 1841 patients, 739 (40.1%) males, and 1102 (59.9%) females, were included. Isolated TH or TH-HG was present in 56 patients, resulting in a prevalence of 3.04%. Of the patients with TH or TH-HG, 15 were men, and 41 were women. TH and TH-HG were significantly more common in women (p=0.038). TH-HG was unilateral in 22 (39.2%) patients and bilateral in 21 (37.5%). Left TH was found in 11 (19.6%) patients, left TH-HG in 29 (51.7%), right TH in eight (14.2%), and left TH-HG in 35 (62.5%).

Conclusion: Hypoplasia of the tentorium is a rare and unknown anomaly that can be easily diagnosed using MRI, and different gyral herniations may accompany TH.

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<![CDATA[Patient Radiation Doses assessment at Diagnostic X-rays Department of King Khalid hospital (KKH)-Majmaah]]>https://eurekaselect.com/article/1303142024-03-28Background: The study was conducted on patients who received diagnostic X-rays in King Khalid Hospital (KKH), Majmaah.

Introduction: The study included the seven most frequently performed investigations, which were carried out on over 1504 patients using digital radiography equipment.

Methods: The X-ray tube's output and exposure parameters were used to calculate the effective dose (ED) and patient entry surface air kerma (ESAK). Additionally, based on these results, conversion coefficients were determined. This study also examined the 75th percentile distributions of ESAK and KAP. The findings of this research were compared with the findings of other researchers throughout the country and the world. The study presents the uncertainty U values, as well as the mean ESAK, KAP, and ED values.

Results: The results of the ESAK, KAP, and ED values were 0.12-5.74 mGy, 0.9-1.84 Gy cm2, and 0.01-0.23 mSv, respectively. As a result, the dosages were much lower than those previously published for the European DRL, national standards, and other studies.

Conclusion: The study concludes that during dose surveys, the importance of detecting and comprehending radiation doses, as well as the proper technique for taking the finest photos possible, can be emphasized to patients in order to assist them in avoiding radioactive particles and radiation exposure.

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<![CDATA[Magnetic Resonance Imaging Findings of Foetal Congenital Toxoplasma Encephalitis: A Case Report]]>https://eurekaselect.com/article/1303172024-03-28 Objective: The purpose of this report is to emphasize that MRI can provide more excellent anatomic information on abnormalities in cerebral parenchyma than ultrasound, which is helpful for the diagnosis of prenatal infectious encephalitis.

Case Presentation: A 38-year-old woman presented to our hospital at a gestation age of 29 weeks due to an ultrasound that showed fetal ventriculomegaly. The fetus demonstrated ventriculomegaly, intrauterine growth restriction, and multiple cystic lesions close to the corticomedullary junction of the frontal, temporal and parietal lobes on both sides. The woman chose to terminate the pregnancy, and pathological examination confirmed the diagnosis of congenital toxoplasma encephalitis.

Conclusion: This is a rare report of MRI manifestations of fetal congenital toxoplasma encephalitis. Detailed knowledge of MRI findings in fetal congenital toxoplasma encephalitis is helpful for prenatal consultation and pregnancy management.]]> <![CDATA[A Fistulized Giant Duodenal Stromal Tumor in a Young Patient: A Case Report With Literature Review for Tomographic Diagnosis]]>https://eurekaselect.com/article/1297882024-03-28Background: Duodenal gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract. It should be considered in the differential diagnosis of periampullary region pathologies.

Case Report: A 24-year-old male patient applied to the general surgery department with the complaint of long-standing abdominal pain, nausea and vomiting after meals, and 8-10 kg weight loss in 1 month. Three-phase dynamic abdominopelvic CT showed that the 1st and the 2nd segments of the duodenum were dilated. At this level, a peripherally intensely contrasted heterogeneous mass lesion, 91x70x46 mm in size, was observed. There was oral contrast and air values in the center of the mass. A fistulized mass connected with the duodenal wall was considered in the differential diagnosis. In the surgical exploration, a soft, vascularized mass fistulized to the 2nd segment of the duodenum was observed. Pathological diagnosis was reported as GIST.

Conclusion: GISTs arise from the precursors of Cajal Interstitial cells of the gastrointestinal tract. Contrast-enhanced CT is the preferred diagnostic method for staging, risk stratification, and follow-up. We presented a young case with a giant duodenal GIST and discussed differential diagnosis and some diagnostic properties.

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<![CDATA[Emergent Endovascular Treatment of Iatrogenous Pseudoaneurysms of the Neck Following Jugular Catheterization]]>https://eurekaselect.com/article/1327002024-03-28Introduction: Inadvertent puncture of the adjacent structures during a central venous catheterization is a well-known complication which may be managed conservatively when the injury is self-limiting, but requires a further treatment when there’s a proof of an active bleeding and/or a growing hematoma.

Case Representation: We report a case of a 57-year-old bone-marrow-transplant patient with neck hematoma and bleeding followed by a non-sonographic-guided central venous line placement. CT showed a right sided hematoma in the neck region with a midline shift of the airway. The patient was under prophylactic LMWH. Emergent angiography demonstrated three different bleeding sites which were successfully embolized with coil and liquid embolic agents by endovascular means.

Conclusion: Interventional radiology offers a quick and safe approach in the management of potentially life-threatening bleeding complications.

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<![CDATA[Combinations of Digital Breast Tomosynthesis and Full-field Digital Mammography for Different Density Types of Breasts]]>https://eurekaselect.com/article/1303842024-03-28Background: The combination of FFDM and DBT can significantly improve the diagnostic efficiency of breast cancer, but with the increase of breast radiation absorbed dose.

Objectives: To compare and analyze the radiation dose and diagnostic performance of different mammography positions combinations of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) for different density types of breasts.

Methods This retrospective study involved 1,195 patients who underwent simultaneous breast DBT and FFDM. The mammography combinations were Group A, FFDM(CC+MLO); Group B, FDM(CC)+DBT(MLO); Group C, FFDM(MLO)+DBT(CC); Group D, DBT(CC+MLO); and Group E, FFDM(CC+MLO)+DBT(CC+MLO). An intergroup comparative analysis of radiation dose and diagnostic performance of different combinations of mammography positions for different breast density types was performed using the pathologic and 24-month follow-up results as the diagnostic basis.

Results: Overall, 2,403 mammograms indicated 477 cases of non-dense breast tissues and 1,926 cases of dense breast tissues. Differences in the mean radiation dose for each non-dense and dense breast group were statistically significant. The areas under the diagnostic receiver operating characteristic (ROC) curves for the non-dense breast group were not statistically significant. In the dense breast group, the z-values were 1.623 (p = 0.105) and 1.724 (p = 0.085) for the area under the ROC curve in Group C compared with Groups D and E, respectively, and 0.724 (p = 0.469) when comparing Group D with Group E. The differences between the remaining groups were statistically significant.

Conclusion: Group A had the lowest radiation dose and no significant difference in diagnostic performance compared with the other non-dense breast groups. Group C had high diagnostic performance in the dense breast group considering the low radiation dose.

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<![CDATA[Early Markers of Sepsis Cardiomyopathy in Murine Models by Echocardiography]]>https://eurekaselect.com/article/1313292024-03-28Background: Strain echocardiography (SE) is a procedure for analyzing myocardial dysfunction that is known to be less dependent on preload and afterload of heart function. Unlike dimension-based parameters, like ejection fraction (EF) and fractional shortening (FS), SE measures cardiac function by tracking cardiac tissue deformation and anomalies throughout the cardiac cycle. Although SE is proven to locate myocardial ailments in various heart diseases, few studies exist regarding using SE relevant to sepsis pathophysiology.

Objective: The study aimed to calculate the myocardial strain and strain rates, like longitudianl strain (LS), global radial strain (GRS), and global longitudinal strain (GLS), and to show these to be reduced earlier in cecal ligation and puncture (CLP) and lipopolysaccharide (LPS)-induced sepsis in coordination with an elevation of pro-inflammatory cytokines.

Methodology: Wild-type mice C57BL/6J (WT) were taken in this study and classified as CLP, LPS, and control groups. CLP surgery and LPS injection were given to induce sepsis. Endotoxemic septic shock was induced by intraperitoneal (IP) injection of LPS Escherichia coli.

Echocardiography short axis views (SAX), longitudinal strain (LS), global circumferential strain (GCS), and global radial strain (GRS) were measured from the anterior and posterior positions of the septal and lateral walls of the heart. Real-time polymerase chain reaction (RT-PCR) was performed to evaluate post-CLP and LPS to analyze cardiac pro-inflammatory cytokines expressions. Inter- and intra-observer variables were tested by Bland-Altman analyses (BA). All data analysis was performed by GraphPad Prism 6 software. p<0.05 was taken as statistically significant.

Results: After 48 hours following CLP and LPS-induced sepsis, a significant declination in both longitudinal strain and strain rate (LS and LSR) was identified in the CLP and LPS groups compared to the control group. Strain depression in sepsis was linked with the up-regulation of proinflammatory cytokines in RT-PCR analysis.

Conclusion: In the present study, we found myocardial strain and strain rate parameters, like LS, GRS, and GLS, to be reduced after CLP and LPS-induced sepsis in coordination with the elevation of pro-inflammatory cytokines.

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<![CDATA[Review for Optimal Human-gesture Design Methodology and Motion Representation of Medical Images using Segmentation from Depth Data and Gesture Recognition]]>https://eurekaselect.com/article/1321502024-03-28 <![CDATA[Investigating Risk Factors and Magnetic Resonance Imaging (MRI)-based Grading of Subchondral Incomplete Fracture (SIF) of Medial Femoral Condyle]]>https://eurekaselect.com/article/1327462024-03-28Background: Subchondral insufficiency fractures (SIF) of the knee joint are prevalent in osteoporosis patients over the age of 55. Early diagnosis of SIF fracture of the medial femoral condyle is crucial for delaying disease progression, early therapy, and potential disease reversal. Magnetic resonance imaging (MRI) is useful in detecting SIF, which is often undetectable on initial radiographs.

This study aimed at developing a grading system for subchondral insufficiency fractures (SIF) based on MRI to predict outcomes and evaluate risk factors.

Methods: In this study, MRI was used to examine SIF risk variables in the medial condyle of the femur to help clinicians diagnose, treat, and delay the condition. A total of 386 patients with SIF from 2019 to 2021 were retrospectively analyzed and divided into 106 patients in the disease group and 280 patients in the control group according to whether they had SIF. The lesion site, meniscus, ligament, and other parameters were evaluated and compared. At the same time, a grading system was introduced to stratify and statistically analyze the size of the lesion area, the degree of bone marrow edema (BME), meniscus tears, and other parameters in the patients.

Results: Most SIF were low-grade (LG) fractures, and the predictors of LG and high-grade (HG) fractures included heel tear (P =0.031), degree of medial malleolus degeneration (P < 0.001), advanced age (P < 0.001), and lesion size (P < 0.001). The prognostic factors that showed significant differences between the two groups included age (P =0.027), gender (P =0.005), side (P =0.005), medial tibial plateau injury (P < 0.0001), femoral medullary bone marrow edema (P < 0.0001), medial tibial plateau bone marrow edema (P < 0.0001), meniscus body partial injury (P =0.016), heel tear (P =0.001), anterior cruciate ligament injury (P =0.002), and medial collateral ligament injury (P < 0.0001).

Conclusion: This current study proposed an MRI-based grading system for inferior condylar fractures of the femur, in which HG inferior condylar fractures are associated with severe medial malleolus degeneration, advanced age, lesion size (correlation), and meniscus heel tears.

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<![CDATA[Reliability of Conventional Hip MRI in Detecting Labral Tear and Labrocartilagenous Lesions in cases of Femoroacetabular Impingement, A Comparative Study with Hip Arthroscopy]]>https://eurekaselect.com/article/1300022024-03-28Background: Imaging studies play a crucial role in diagnosing femoroacetabular impingement (FAI), including plain radiography and Magnetic Resonance Imaging (MRI). FAI is a combined pathology of bony abnormality, labral and labrocartilagenous erosions. Surgical treatment for such cases has become more established and preoperative imaging is the roadmap that includes the assessment of labrum and articular cartilage.

Methods: During a period of 2 years, thirty-seven patients with a clinical diagnosis of FAI were retrospectively enrolled in this study, including 17 men and 20 women, aged 27–62 years. There were 22 right hips and 15 left hips. MRI was done for all patients to identify bony details, labral and chondral abnormalities and to exclude coexisting disorders. The imaging findings were compared with the arthroscopic data.

Results: 15 patients had Pincer FAI, 11 patients had CAM, and 11 patients had combined Cam/Pincer FAI. Labral tear was detected in 100% of patients, 97% had an anterosuperior labral tear. 82% of patients had partial thickness cartilage lesions and 8% had full thickness cartilage lesions. MRI had a sensitivity of 100% compared to hip arthroscopy in detecting labral tear, 60% in detecting cartilage erosion.

Conclusion: Conventional hip MRI detects bony changes in FAI, type of impingement and associated labral tear and cartilage erosions in comparison to the hip arthroscopy.

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<![CDATA[MRI Appearances of Stage IA Ovarian Carcinoma]]>https://eurekaselect.com/article/1300062024-03-28Objective: To analyze the MRI findings of stage IA ovarian cancer.

Methods: 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.

Results: 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.

Conclusion: 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.

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<![CDATA[Intravoxel Incoherent Motion Diffusion-weighted MRI Assessing the Effect of the Vascular Disrupting Agent CA4P on VX2 Liver Tumors in Rabbits]]>https://eurekaselect.com/article/1300092024-03-28Objective: 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).

Methods: 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.

Results: 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).

Conclusion: 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.

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<![CDATA[Diagnostic Value of Chest X-Ray in Febrile Patients without Localizing Signs or Symptoms at the Emergency Department]]>https://eurekaselect.com/article/1301132024-03-28Background: 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.

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

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

Patients: 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.

Main Measures: 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.

Key Results: 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.

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

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<![CDATA[Modified Exigent Features Block in JAN Net for Analysing SPECT Scan Images to Diagnose Early-Stage Parkinson’s Disease]]>https://eurekaselect.com/article/1322792024-03-28Background: The quantitative measure of dopamine transporter (DaT) in the human midbrain is generally used as a biomarker for analyzing Parkinson’s disease (PD).

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

Methods: 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.

Results: 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.

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

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<![CDATA[A Review on Imaging Techniques and Artificial Intelligence Models for Osteoporosis Prediction]]>https://eurekaselect.com/article/1323912024-03-28 <![CDATA[Carbonated Beverages and Puffed Foods Cause Gastric Rupture: A Case Report]]>https://eurekaselect.com/article/1323922024-03-28Introduction: 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.

Case Presentation: 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.

Conclusion: 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.

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<![CDATA[3D Synthetic Brain MRI with Compressed Sensing: Can It be a Promising way Forward for Daily Neuroimaging?]]>https://eurekaselect.com/article/1324722024-03-28Background: 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).

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

Methods: 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.

Results: 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.

Conclusion: 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.

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<![CDATA[Semi-automatic Framework for Voxel Human Deformation Modeling]]>https://eurekaselect.com/article/1324882024-03-28Background: 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.

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

Methods: 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.

Results: 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.

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

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<![CDATA[Prolapsed Uterine Smooth Muscle Tumor of uncertain Malignant Potential: A Case Report and Review of Radiological Findings]]>https://eurekaselect.com/article/1325092024-03-28Introduction: 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.

Case Description: 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.

Conclusion: 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.

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<![CDATA[Arthritis of the Hip Caused by Arteriovenous Malformations: A Case Report]]>https://eurekaselect.com/article/1325102024-03-28Background: 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.

Case Summary: 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.

Conclusion: 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.

Core Tip: 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.

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<![CDATA[Cerebellopontine Angle Lipoma with Contralateral Sudden Deafness: A Case Report and Review of Literature]]>https://eurekaselect.com/article/1325862024-03-28Background: 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.

Case Presentation: 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.

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

Conclusion: 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.

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<![CDATA[Kikuchi-fujimoto Disease in the Axilla after COVID-19 Vaccination: A Case Report]]>https://eurekaselect.com/article/1325872024-03-28Background: 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.

Case Presentation: 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.

Conclusion: 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.

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<![CDATA[A Light, 3D UNet-based Architecture for fully Automatic Segmentation of Prostate Lesions from T2-MRI Images]]>https://eurekaselect.com/article/1319972024-03-28Introduction: 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.

Methods: 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.

Results: 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.

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

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<![CDATA[Review of Magnetic Resonance Imaging and Post-processing for the Brain Tumor-related Epilepsy Study]]>https://eurekaselect.com/article/1312212024-03-28 <![CDATA[Quantification of Iron Deposition in the Brain of Hypertensive Patients using 3D-enhanced Susceptibility-weighted Angiography (ESWAN)]]>https://eurekaselect.com/article/1327022024-03-28Background: Cerebral microbleeds (CMBs) are commonly present in patients with hypertension, producing iron-containing metabolites. A small amount of regional iron deposition is hardly discernible on conventional magnetic resonance imaging (MRI). Three-dimensional enhanced susceptibilityweighted angiography (ESWAN) provides tissue images with high spatial resolution and signal-noise ratio, and has been widely used to measure brain iron deposition in neurodegenerative diseases and intracranial hemorrhage.

Objective: The study aimed to demonstrate iron deposition in the brain of hypertensive patients using ESWAN.

Methods: Twenty-seven hypertension patients, with or without CMBs, and 16 matched healthy controls (HCs) were enrolled. From the post-processed ESWAN images, phase and magnitude values of the regions of interest (ROIs) were calculated. Two-sample t-test and one-way variance analysis were applied to compare groups. The relationship between ESWAN parameters and clinical variables was assessed using Pearson’s correlation coefficient.

Results: Compared to HCs, the phase value of the hippocampus, head of caudate nucleus (HCN), and substantia nigra (SN) was decreased in hypertension with the CMBs subgroup, while that of HCN and SN was decreased in hypertension without CMBs subgroup. Similarly, the magnitude value of the hippocampus, HCN, thalamus red nucleus, and SN was significantly lower in the hypertension group than HCs. In addition, the phase and magnitude values showed a correlation with clinical variables, including disease duration and blood pressure.

Conclusion: Deep grey matter nuclei displayed greater iron content in hypertension patients. Iron deposition may precede the appearance of CMBs on MRI, serving as a potential marker of microvascular damage.

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<![CDATA[Radiographic and Ultrasonographic Evaluation of the Rare Sesamoid Bone of the Elbow: Os Subepicondylare Mediale]]>https://eurekaselect.com/article/1306962024-03-28Background: 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.

Case Presentation: 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.

Conclusion: 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.

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<![CDATA[A First Report of Thyroid Pneumatosis as a Complication of Ultrasound-guided Thyroid Biopsy]]>https://eurekaselect.com/article/1306972024-03-28Background: 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 ultrasoundguided FNA.

Case Presentation: 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.

Conclusion: 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.

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<![CDATA[The Radiological Evaluation of the Anatomy of the Alveolar Antral Artery and the Lateral Wall Thickness Using Cone-beam Computed Tomography: A Retrospective Study]]>https://eurekaselect.com/article/1300012024-03-28Objectives: Study aims to assess the position and route of the alveolar antral artery and the lateral wall thickness of the maxillary sinus using cone-beam computed tomography (CBCT), reducing the risk of complications and improving the success rate of surgery.

Materials and Methods: This study included CBCT scans from 238 patients. The detection diameter of AAA and distance of the lower border of AAA to the maxillary sinus floor at the first premolar, second premolar, first molar, and second molar locations were evaluated. The route of AAA was observed with novel classification. Furthermore, the distance from the maxillary sinus floor to the alveolar crest at four posterior tooth locations was measured respectively. Moreover, the lateral wall thickness at four locations was assessed. Data were subjected to statistical analysis.

Results: AAA was observed in 62.18% of all sinuses. The mean diameter was 0.99±0.21 mm, with significant differences within gender. Half of the route of AAA was intrasinus intraosseous type. The mean distance between the maxillary sinus floor and AAA was 8.00±2.68 mm, with a significant difference between dentate and edentulous status at the first molar location. Distance from the sinus floor to the alveolar ridge crest in edentulous status negatively correlated with the distance from the sinus floor to AAA at the first molar location. The mean thickness of the lateral wall was 2.03±0.91 mm, and the difference in thickness between males and females at the four locations was statistically significant.

Conclusion: Intrasinus-intraosseous type, is the most common route. Special care should be taken at the first molar location during a lateral window sinus floor elevation. CBCT is highly recommended to before lateral wall maxillary sinus floor elevation.

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<![CDATA[A Rare Cause of Obstructive Jaundice and Pancreatitis; Lemmel's Syndrome]]>https://eurekaselect.com/article/1300072024-03-28Introduction: 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.

Case Presentation: 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.

Conclusion: 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.

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<![CDATA[Pericholecystic Varices as the Predominant Manifestation in Cryptogenic Portal Hypertension: A Case Report]]>https://eurekaselect.com/article/1308072024-03-28Background: Portal hypertension has various manifestations, and varices are a common manifestation. Varices can appear in any vein in the body associated with the portal venous system.

Case Presentation: Herein, we report a case of portal hypertension with gallbladder varices as the main manifestation, which was confirmed by abdominal contrastenhanced CT with three-dimensional reconstruction and color Doppler ultrasonography. The patient had concomitant liver cirrhosis and portal vein thrombosis. Various auxiliary examinations and biochemical indicators of the patient confirmed liver cirrhosis, portal vein thrombosis, and portal hypertension, all of which were mild and did not reach the decompensation stage.

Conclusion: As illustrated by this case, when there is an embolism in certain parts of the portal system, portal hypertension can appear during the compensatory period and transition into severe varices in the thrombotic part during the de-compensatory period.

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<![CDATA[Volumetric Modulated Arc Radiotherapy Efficacy after Double Recurrences of Cardiac Sarcoma]]>https://eurekaselect.com/article/1308102024-03-28Background: Volumetric Modulated Arc Therapy (VMAT) has recently become a pivotal treatment of oncological diseases due to the high-precise delineation of target volume contours with sparing organs at risk. This procedure requires a high level of experience and precision and is achievable only with advanced diagnostic support. Magnetic Resonance (MRI) and multimodality imaging, such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), are fundamental in implementing radiotherapy guidance.

Case Report: A 54-year-old patient underwent surgery twice to remove primitive and recurrent cardiac sarcomas of the left atrium. The appearance of a further relapse required radiotherapy as the only possible treatment. Cardiac MRI was then performed to define the degree of atrial mass invasiveness, and 18F-FDG PET/CT was performed to assess the activity and staging of the cardiac lesion. It revealed high 18F-FDG uptake not only in the left atrium lesion but also in a pancreatic lesion with elevated 18F-FDG uptake (SUV max 5.5). The pancreatic biopsy performed a few days later confirmed the myxoid sarcoma metastasis, and surgeons defined it as not operable due to the patient’s clinical condition. Radiotherapy was then urgently performed with the VMAT technique. After 40 days, a cardiac MRI showed a reduction in the cardiac mass with improvement in the respiratory and cardiac symptoms; then, the patient started chemotherapy. One year after diagnosis, the patient is still alive and is receiving chemotherapy with gemcitabine and docetaxel with good compliance.

Conclusion: The correct and timely management of a patient suffering from a rare oncological disease has allowed a better and longer survival, especially due to VMAT, a sophisticated procedure that requires high expertise. This case also demonstrates that cardiac MRI and whole-body imaging procedures, such as 18FDG PET/CT, can be useful in staging patients with oncological diseases.

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<![CDATA[Calcific Tendinopathy Atypically Located Outside the Rotator Cuff: A Systematic Review]]>https://eurekaselect.com/article/1308112024-03-28Background and Purpose: Calcific tendinopathy is a common cause of painful shoulder easily identified with ultrasound or conventional radiography. Although the rotator cuff is by far the most common location of the disease and diagnostic or treatment strategies are well known in clinical practice, a lack of awareness characterizes the assessment of the other sites affected by this condition; consequently, the risk of underestimating the prevalence of atypical non-rotator cuff calcific tendinopathy is high. This may lead to expensive or invasive diagnostic exams and/or inappropriate treatment, whereas the condition is usually self-limited.

The present study aims at analysing the frequency of calcific tendinitis in uncommon sites, in order to fill a gap in knowledge and awareness regarding non-rotator cuff calcific tendinopathy, thus avoiding improper clinical choices and helping to identify this condition.

Methods: This systematic review was conducted following the PRISMA guidelines. We performed a search on Pubmed and Scopus databases concerning atypically sited extra-rotator cuff calcific tendinopathy published since 1950.

Results: The research found a total of 267 articles and 793 non-rotator cuff cases of calcific tendinopathy registered. The spine (213 – 26.86%), foot and ankle (191 – 23.95%), and hip (175 – 22.06%) appeared to be the most common sites of calcific tendinopathy after the rotator cuff, whereas the longus colli C1-C2 (204 – 25.72%), Achilles (173 – 21.81%), and rectus femori (61 – 7.69%) were the most commonly affected tendons.

Conclusion: A better awareness of this condition in several different sites of the body than the rotator cuff could avoid unnecessary choices both in assessment and treatment.

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<![CDATA[Spontaneous Thyroid Parenchymal Hemorrhage Causing Acute Airway Obstruction and Its Endovascular Treatment: A Case Report and Literature Review]]>https://eurekaselect.com/article/1303122024-03-28Introduction: Massive parenchymal hemorrhage of the thyroid gland is very rare. Some of these can reach a life-threatening level.

Case Presentation: A 70-year-old female patient approached the emergency department with swelling and redness on her neck after a routine dialysis session. In the neck computed tomography obtained, there was a massive hematoma originating from the thyroid gland parenchyma. The hematoma was causing airway compression. We performed thyroid artery embolization and within days, hematoma dimensions and compression effect disappeared without surgical treatment.

Conclusion: Massive hemorrhage of the thyroid gland parenchyma is very rare and can reach life-threatening dimensions. Effective and rapid treatment should be done. As an alternative to surgery, endovascular treatment can be life-saving.

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<![CDATA[Pseudoaneurysm of a Lumbal Artery: CT-guided Treatment with Nonadhesive Liquid Embolic Agent]]>https://eurekaselect.com/article/1303212024-03-28Introduction: A 65-year-old patient presented with subtle lumbalgia twenty days following his failed endovascular retrograde recanalization of the right iliac artery, followed by a surgical femoral-femoral left-to-right by-pass graft.

Case Presentation: Computer tomography angiography (CTA) revealed a left-sided 18 mm large pseudoaneurysm (PA) at the level of L5 lumbar vertebrae adjacent to the aorta. This lumbal artery originated from the false lumen of the known chronic infrarenal aortic dissection. Within a single session, the pseudoaneurysm was treated by percutaneous nonadhesive liquid embolic agent (NALEA - Onyx 34) embolization under CT-fluoroscopy guidance. Follow-up imaging showed complete occlusion of the PA.

Conclusion: This case shows the first usage of Onyx as a liquid embolic agent for this complication.

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<![CDATA[Potential Value of the Stretched Exponential and Fractional Order Calculus Model in Discriminating Between Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: An Animal Experiment of Orthotopic Xenograft Nude Mice]]>https://eurekaselect.com/article/1303222024-03-28Background: In clinical practice, Preoperative differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma is challenging but critical for treatment decisions.

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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<![CDATA[Enlargement of the Middle Meningeal Artery may be an Initiating Factor of Chronic Subdural Hematoma: Three Rase reports and a Literature Review]]>https://eurekaselect.com/article/1303442024-03-28Background: MMA (middle meningeal artery) embolization for the treatment of refractory CSDH (chronic subdural hematoma) was first described by Mandai et al. in 2000. More surgeons hadbegun to pay attention to such surgery to treat CSDH and explored the changes in the middle meningealartery in the formation of hematomas.

Case Presentation: We present three cases of chronic subdural hematoma after head trauma and compared the diameter of middle meningeal artery in MRA images before and after chronic subduralhematoma to discuss our new understanding of CSDH.

Conclusion: The enlarging of MMA was found through MRA in patients with craniocerebral trauma on one side but not on the other. However, only the enlarged side had a subdural hematoma, so we speculate that the enlargement of MMA might be one of the initiating factors of CSDH.

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<![CDATA[A Case Report of Bone Paget's Disease with Concurrent Psoriasis and Positive Celiac Serology]]>https://eurekaselect.com/article/1303602024-03-28Background: Paget's disease of bone (PDB) is the second most frequent metabolic bone disease affecting about 3 percent of the Caucasian population older than 55 years. Its etiopathogenesis is unknown. While viral agents like measles and respiratory syncytial virus has been proposed, the role of genetic susceptibility loci such as SQSTM1/p62 gene mutations have been confirmed. A new inhibitory mechanism against osteoprotegerin (OPG) via autoantibodies has been revealed in a patient with occult celiac disease (CD) with a phenotype similar to juvenile Paget's disease, which suggests an immunological mechanism for Paget's disease-like disorders other than genetic causes. But there is no report in the literature addressing the shared immunological mechanisms underlying classic PDB, CD and psoriasis.

Case Presentation: Herein, the case of a 50-year-old Caucasian man being reported with progressive bilateral hearing loss. The patient had a history of total blindness which had developed shortly after a cranial osteotomy for optic nerve decompression without any specific diagnosis 15 years ago. He had also been suffering chronic psoriasis vulgaris. Because of his enlarged skull, a diagnosis of bone Paget's disease was suspected and plain radiographs revealed a polyostotic Paget's disease with characteristic radiologic signs. In searching for his refractory constipation causes, an elevated level of tissue transglutaminase IgA (tTG IgA) antibody was demonstrated. Alendronate sodium 40 mg daily was started and a gluten-free diet was recommended to him but he was not adherent to the treatments and lost to follow-up.

Conclusion: This case further supports the idea of considering PDB as an osteoimmunologic disorder, like psoriasis and CD, because of similar biochemical features, including elevated levels of Cytokines such as interleukin-6 and tumor necrosis factor- α as well as bone resorption markers such as OPG and urinary deoxypyridinoline. So, the treatment of Paget’s disease of the bone may benefit from progresses in osteoimmunology-targeted therapies. Also a probable causal relationship between PDB and CD either by production of neutralizing antibodies in CD against OPG or by inducing PDB in genetically susceptible patients through oxidative stress, has been postulated here.

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<![CDATA[Role of Magnetic Resonance Imaging in the Diagnosis of Placenta Accreta]]>https://eurekaselect.com/article/1327032024-03-28Introduction: To analyze the value of magnetic resonance imaging (MRI) in suspicious cases for prenatal detection of placenta accreta (PA).

Materials and Methods: A total of 50 placental MRI exams performed on a 1.5T scanner were retrospectively reviewed by two radiologists in consensus. HASTE (half- Fourier acquisition single-shot turbo spin echo)and True-FISP (true fast imaging with steady-state precession) sequences were acquired. Findings from MRI were compared with the final diagnosis, which was determined by clinical findings at delivery and pathological examination of specimens.

Results: Of 50 pregnant women in the analysis, 33 required cesarean hysterectomy, and 17 underwent cesarean delivery.MRI signs such as myometrial thinning, loss of T2 hypointense interface(loss of retroplacental clear space on US), heterogenous intraplacental sign, and intraplacental T2 dark bands were more likely to be seen in this group.

In this group, the cases that were finally clinically and pathologically confirmed were 12, 16, and 22 cases of placenta accreta vera, placenta increta, and placenta percreta respectively.

Conclusion: MRI is particularly useful in cases where US is inconclusive and to assess the extent to which the placenta penetrates the uterine serosa and invades outward into surrounding tissues.MRI has become a routine examination for patients with suspected PA in clinical practice.

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<![CDATA[Multisite Percutaneous Bone Augmentation for the Treatment of Acetabular Osteolytic Metastases Involving the Articular Surfaces: A Randomised Trial]]>https://eurekaselect.com/article/1303822024-03-28Introduction: For patients with acetabular osteolytic metastases involving the articular surfaces, current treatments cannot efficiently rebuild the acetabular bone frame structure and strengthen bone defect area mechanics for weight-bearing. The purpose of this study is to show the operational procedure and clinical outcomes of multisite percutaneous bone augmentation (PBA) for the treatment of incidental acetabular osteolytic metastases involving the articular surfaces.

Methods: According to the inclusion and exclusion criteria, 8 patients (4 males and 4 females) were included in this study. Multisite (3 or 4 sites) PBA was successfully performed in all patients. The pain and function evaluation and imaging observation were examined by VAS and Harris hip joint function scores at the different time points (pre-procedure, 7 days, one month, last follow-up in 5-20 months).

Results: There were significant differences (p<0.05) in VAS and Harris scores before and after the surgical procedure. Moreover, these two scores had no obvious changes during the follow-up process (7 days after the procedure, one month after the procedure, and the last follow-up) after the procedure.

Conclusion: The proposed multisite PBA is an effective and safe procedure for the treatment of acetabular osteolytic metastases involving the articular surfaces.

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<![CDATA[CT and MRI Features of Chondrosarcoma in the Mastoid Involving the Facial Nerve in Comparison to Facial Nerve Schwannoma]]>https://eurekaselect.com/article/1303852024-03-28Background: Chondrosarcoma in the mastoid is extremely rare, and it is easily misdiagnosed as a facial nerve schwannoma.

Objective: To identify and compare computed tomography (CT) and magnetic resonance imaging (MRI) features of chondrosarcoma in the mastoid involving the facial nerve, including diffusion-weighted MRI characteristics, with those of facial nerve schwannoma.

Methods: CT and MRI features of 11 chondrosarcomas in the mastoid involving the facial nerve and 15 facial nerve schwannomas, confirmed by histopathology, were retrospectively reviewed. The tumor location, size, morphological features, bone change, calcification, signal intensity, texture, enhancement characteristics, the extent of lesions, and apparent diffusion coefficients (ADCs) were evaluated.

Results: On CT imaging, calcification could be found in 81.8% of chondrosarcomas (9/11) and 33.3% of facial nerve schwannomas (5/15). Chondrosarcoma in the mastoid appeared significantly hyperintense on T2-weighted images (T2WI) with low signal intensity septa in eight patients (72.7%, 8/11). After contrast, all chondrosarcomas showed inhomogeneous enhancement, and septal and peripheral enhancement could be found in six cases (54.5%, 6/11). Facial nerve schwannoma demonstrated inhomogeneous hyperintensity on T2WI in 12 cases (80%, 12/15), with obvious hyperintense cystic changes in seven cases. There were significant differences in calcification (P=0.014), T2 signal intensity (P=0.006), and septal and peripheral enhancement (P=0.001) between chondrosarcomas and facial nerve schwannomas. The ADCs of chondrosarcoma were significantly higher than those of facial nerve schwannomas (P<0.001).

Conclusion: CT and MRI with ADCs had the potential to improve the diagnostic accuracy of chondrosarcoma in the mastoid involving the facial nerve.

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<![CDATA[Evaluation of Interstitium by Lymphatic Uptake Method in Chronic Bilateral Lower Extremity Edema]]>https://eurekaselect.com/article/1303862024-03-28Objective: Symmetrical bilateral lower extremity edema (BLEE) needs to be treated effectively. Finding the cause of this condition increases the success of treatment. Fluid increase in the interstitial space (FIIS) is always present as a cause or a result. Subcutaneously administered nanocolloid is transported by uptake by lymphatic pre-collectors, and this uptake takes place in the interstitium. We aimed to evaluate the interstitium with labeled nanocolloid and contribute to the differential diagnosis in cases with BLEE.

Methods: Our retrospective study included 74 female patients who underwent lymphoscintigraphy for bilateral lower extremity edema. Technetium 99m (Tc-99m) albumin colloid (nanocolloid), a marked colloidal suspension, was applied subcutaneously to two different areas on the dorsum of both feet with a 26 gauge needle The dose volume administered intradermally is approximately 0.2-0.3 ml, and each injector has 22-25MBq of activity. Siemens E-Cam dual-headed SPECT gamma camera was used for imaging. Dynamic and scanning images were taken with a high-resolution parallel hole collimator. Ankle images were re-evaluated by two nuclear medicine specialists, independent of physical examination and scintigraphy findings.

Results: 74 female patients with bilateral lower extremity edema were divided into two groups based on physical examination and lymphoscintigraphy findings. There were 40 and 34 patients in Groups I and II, respectively. In the physical examination, patients in Group I were evaluated as lymphedema, and patients in Group II were evaluated as lipedema. The main lymphatic channel (MLC) was not observed in any of the patients in Group I in the early images, and the MLC was observed at a low level in the late imaging in 12 patients. The sensitivity of the presence of distal collateral flows (DCF) in the presence of significant MLC in early imaging in demonstrating increased fluid in the interstitial space (FIIS) was calculated as 80%, specificity as 80%, PPV 80%, and NPV 84%.

Conclusion: While MLC is present in early images, concomitant DCF occurs in cases of lipoedema. The transport of increased lymph fluid production in this group of patients can be covered by the existing MLC. Although MLC is evident, the presence of significant DCF supports the presence of lipedema. It can be used as an important parameter in the diagnosis in early cases where physical examination findings are not evident.

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<![CDATA[Comparison between Conventional Breath-hold and Respiratory-triggered Magnetic Resonance Cholangiopancreatography with and without Compressed Sensing: Cross-sectional Study]]>https://eurekaselect.com/article/1303882024-03-28Introduction: The application of compressed sensing (CS) has enabled breath-hold 3D-MRCP with a shorter acquisition time in clinical practice.

Aim: To compare the image quality of breath-hold (BH) and respiratory-triggered (RT) 3D-MRCP with or without CS application in the same study population.

Methods: In this retrospective study, from February to July 2020, a total of 98 consecutive patients underwent four different acquisition types of 3D-MRCP.; 1) BH MRCP with the generalized autocalibrating partially parallel acquisition (GRAPPA) (BH-GRAPPA), 2) RT-GRAPPA-MRCP, 3) RT-CSMRCP and 4) BH-CS-MRCP. Relative contrast of common bile duct, 5-scale visibility score of biliary pancreatic ducts, 3-scale artifact score and 5-scale overall image quality score were evaluated by two abdominal radiologists.

Results: Relative contrast value was significantly higher in BH-CS or RT-CS than in RT-GRAPPA (0.90 ± 0.057 and 0.89 ± 0.079, respectively, vs. 0.82 ± 0.071, p < 0.01) or BH-GRAPPA (vs. 0.77 ± 0.080, p < 0.01). The area affected by artifact was significantly lower in BH-CS among 4 MRCPs (p < 0.01). Overall image quality score in BH-CS was significantly higher than BH-GRAPPA (3.40 vs. 2.71, p < 0.01). There were no significant differences between RT-GRAPPA and BH-CS (vs. 3.13, p = 0.67) in overall image quality.

Conclusion: In this study, our results revealed BH-CS had higher relative contrast and comparable or superior image quality among four MRCP sequences.

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<![CDATA[Concurrent Diffuse Dural and Leptomeningeal Enhancements in Brain Magnetic Resonance Imaging Following a Mild COVID-19 Infection: A Novel Case Report and Review of Literature]]>https://eurekaselect.com/article/1303932024-03-28Introduction: During the COVID-19 pandemic, various complications have been reported in patients with this infection worldwide, including a wide range of neurological disorders. In this study, we have reported a novel neurological complication in a 46-years-old woman who was referred due to a headache following a mild COVID-19 infection. Also, we have had a quick review of previous reports of dural and leptomeningeal involvements in COVID-19 patients.

Case Report: The patient's headache was persistent, global, and compressive with radiation to the eyes. The severity of the headache was increased during the disease course and was exacerbated by walking, coughing, and sneezing but decreased with rest. The high severity of the headache disrupted the patient’s sleep. Neurological examinations were completely normal, and laboratory tests did not have abnormal findings except for an inflammatory pattern. Finally, in the brain MRI, a concurrent diffuse dural enhancement and leptomeningeal involvement were observed, which is a new finding in COVID-19 patients and has not been reported so far. The patient was hospitalized and treated with Methylprednisolone pulses. After completing the therapeutic course, she was discharged from the hospital in good condition and with an improved headache. A repeated brain MRI was requested 2 months after discharge, which was completely normal and showed no evidence of dural and leptomeningeal involvements.

Conclusion: Inflammatory complications of the central nervous system caused by COVID-19 can occur in different forms and types, and clinicians should consider them.]]> <![CDATA[Clinical Usefulness of Ultrasound Elastography in Colonic Diseases: A Narrative Review]]>https://eurekaselect.com/article/1305352024-03-28 <![CDATA[Quantitatively Measured Infrapatellar Fat Pad Signal Intensity Alteration is Associated with Joint Effusion-synovitis in Knee Osteoarthritis]]>https://eurekaselect.com/article/1300982024-03-28Objective: The objective of this study is to investigate whether quantitatively measured infrapatellar fat pad (IPFP) signal intensity alteration is associated with joint effusion-synovitis in people with knee osteoarthritis (OA) over two years.

Methods: Among 255 knee OA patients, IPFP signal intensity alteration represented by four measurement parameters [standard deviation of IPFP signal intensity (IPFP sDev), upper quartile value of IPFP high signal intensity region (IPFP UQ (H)), ratio of IPFP high signal intensity region volume to whole IPFP volume (IPFP percentage (H)), and clustering factor of IPFP high signal intensity (IPFP clustering factor (H))] was measured quantitatively at baseline and two-year follow-up using magnetic resonance imaging (MRI). Effusion-synovitis of the suprapatellar pouch and other cavities were measured both quantitatively and semi-quantitatively as effusion-synovitis volume and effusion-synovitis score at baseline and two-year follow-up using MRI. Mixed effects models assessed the associations between IPFP signal intensity alteration and effusion-synovitis over two years.

Results: In multivariable analyses, all four parameters of IPFP signal intensity alteration were positively associated with total effusion-synovitis volume and effusion-synovitis volumes of the suprapatellar pouch and of other cavities over two years (all P<0.05). They were also associated with the semiquantitative measure of effusion-synovitis except for IPFP percentage (H) with effusion-synovitis in other cavities.

Conclusion: Quantitatively measured IPFP signal intensity alteration is positively associated with joint effusion-synovitis in people with knee OA, suggesting that IPFP signal intensity alteration may contribute to effusion-synovitis and a coexistent pattern of these two imaging biomarkers could exist in knee OA patients.

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<![CDATA[Evaluating Diagnostic Efficiency of Thyroid Imaging Reporting and Data Systems proposed by the American College of Radiology in Surgically Resected Thyroid Nodules]]>https://eurekaselect.com/article/1303132024-03-28Aim: Thyroid nodules are one of the most common clinical findings, with a prevalence of 68% in adults. Thyroid cancer is the fifth most common cancer in women.

Introduction: The purpose of this study is to evaluate the diagnostic efficacy of Thyroid Imaging Reporting and Data Systems proposed by the American College of Radiology (ACR-TIRADS) for the diagnosis of malignancy in surgically resected thyroid nodules.

Methods: In this retrospective study, patients who underwent thyroid nodules resected surgically from 2018-2020 were included. Before resection, an ultrasound was performed for TIRADS scores, and after resection histopathology, thyroid mass was obtained. The outcomes of the two systems were statistically compared.

Results: The mean age of the 146 included patients was 47.6 ± 14.08 years, of which 109 (74.7%) were female. Based on TIRADS, 47 patients (32.2%) were in TI-RADS TR3, 36 patients (24.7%) were in TIRADS TR2, 34 (23.3%) in TIRADS 4, 24 (16.4%) in TIRADS TR5 and 5 patients (3.4%) were in TIRADS TR1. The overall sensitivity was 79.9% when ACR-TIRADS TR4 was set as a diagnostic cutoff value. Considering the total of TIRADS TR4 and TIRADS TR5 as predictors of thyroid malignancy, the sensitivity was 74.5% and the specificity was 76.8%. The positive and negative predictive value was 60.3% and 76.8%.

Conclusion: ACR-TIRADS 4 and 5 can be considered good predictors of malignancy in thyroid nodules. More studies, including larger samples, are required to obtain a better conclusion.

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<![CDATA[Alcoholic/Nonalcoholic Fatty Liver Disease Detection with Transient Elastography: A Detailed Review and Meta-analysis]]>https://eurekaselect.com/article/1297232024-03-28Background: The liver plays a significant role in the digestive system, and disease in the liver initiates various other problems. The liver is severely affected due to alcohol use, and it initiates various chronic diseases, including Alcohol-Related Liver Disease (ARLD). Alcoholic/Nonalcoholic Fatty Liver Disease (AFLD/NFLD) is a severe medical emergency, and early screening and treatment are necessary to cure the patient. The untreated AFLD/NFLD will cause various problems, including fatigue, weight loss, and discomfort in the abdomen.

Objective: This study aims to present a detailed review and investigation of schemes considered in medical clinics to identify the AFLD/NFLD coupled problems and present the merit of the Transient Elastography (TE) combined with Fibroscan® practice to identify liver abnormality.

Methods: This research aims to study the clinical significance and the accuracy of TE-supported liver illness screening.

Results: This work aims to collect the recent research works and clinical reports published from 2011 to 2021 from the chosen databases and provide a detailed review using the clinical information discussed in the selected articles.

Conclusion: The essential statistical investigation of the collected data is executed with Review Manager (RevMan®) software, and the significance of the TE is confirmed using the articles supporting a 2x2 contingency table, and each case is evaluated using a p-score and the Region of Convergence (RoC) curve for 95% confidence intervals.

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<![CDATA[Multivariate Prediction of Small-bowel Ischemia and Necrosis using CT in Emergent Patients with Small-bowel Obstruction]]>https://eurekaselect.com/article/1333052024-03-28Background: It is difficult to accurately determine whether emergent patients with small-bowel obstruction (SBO) have small-bowel ischemia and necrosis (SBIN). Therefore, in this study, we aimed to assess the ability of abdominal CT scans to predict SBIN and establish a new predictive model.

Methods: From March 2018 to May 2023, a rigorous posthoc analysis was conducted on whether 177 emergent patients with SBO had SBIN. Four clinical indexes and 19 CT signs were analyzed, and a multivariate scoring model for predicting SBIN was established using logistic regression analysis. A receiver operating characteristic (ROC) curve was used to assess the accuracy of this model.

Results: Multivariate analysis showed that mesenteric edema and effusion (OR=23.450), significant thickening and the target sign on the small-bowel wall on plain scans (OR=23.652), significant thinning of the small-bowel wall (OR=30.439), significant decrease in small-bowel wall density (OR=12.885), and significant increase in small-bowel wall density (OR=19.550) were significantly correlated with SBIN (P<0.05). According to their multivariate ORs, an appropriate “predictive score” was assigned to each sign, and the rates of SBIN among those with a total score of 0-4, 5-6, and 7-8 were 2.2%, 86.4%, and 96.9%, respectively. The AUC of this predictive scoring model for SBIN exceeded 0.980.

Conclusion: We have developed a predictive scoring model for SBIN, for which the incidence of SBIN increases with increasing predictive scores. This model can be useful for clinical treatment.

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<![CDATA[Thyroid Nodules Classification using Weighted Average Ensemble and DCRITIC Based TOPSIS Methods for Ultrasound Images]]>https://eurekaselect.com/article/1306912024-03-28Background: Thyroid disorders are prevalent worldwide and impact many people. The abnormal growth of cells in the thyroid gland region is very common and even found in healthy people. These abnormal cells can be cancerous or non-cancerous, so early detection of this disease is the only solution for minimizing the death rate or maximizing a patient's survival rate. Traditional techniques to detect cancerous nodules are complex and timeconsuming; hence, several imaging algorithms are used to detect the malignant status of thyroid nodules timely.

Aim: This research aims to develop computer-aided diagnosis tools for malignant thyroid nodule detection using ultrasound images. This tool will be helpful for doctors and radiologists in the rapid detection of thyroid cancer at its early stages. The individual machine learning models are inferior to medical datasets because the size of medical image datasets is tiny, and there is a vast class imbalance problem. These problems lead to overfitting; hence, accuracy is very poor on the test dataset.

Objective: This research proposes ensemble learning models that achieve higher accuracy than individual models. The objective is to design different ensemble models and then utilize benchmarking techniques to select the best model among all trained models.

Methods: This research investigates four recently developed image transformer and mixer models for thyroid detection. The weighted average ensemble models are introduced, and model weights are optimized using the hunger games search (HGS) optimization algorithm. The recently developed distance correlation CRITIC (D-CRITIC) based TOPSIS method is utilized to rank the models.

Results: Based on the TOPSIS score, the best model for an 80:20 split is the gMLP + ViT model, which achieved an accuracy of 89.70%, whereas using a 70:30 data split, the gMLP + FNet + Mixer-MLP has achieved the highest accuracy of 82.18% on the publicly available thyroid dataset.

Conclusion: This study shows that the proposed ensemble models have better thyroid detection capabilities than individual base models for the imbalanced thyroid ultrasound dataset.

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<![CDATA[Assessment of Thyroid Function in Patients with Rheumatoid Arthritis in Kunming, China: A Case-control Study]]>https://eurekaselect.com/article/1306932024-03-28Introduction: The present study aimed to analyze the prevalence of hypothyroidism in patients with rheumatoid arthritis (RA). In addition, the study aimed to elucidate the correlation of hypothyroidism with RA activity and to investigate the relationship between RA and thyroid dysfunction.

Materials and Methods: A total of 314 patients were categorized into two groups according to thyroid stimulating hormone (TSH) level: RA without hypothyroidism and RA with hypothyroidism. All patients underwent routine laboratory investigation, including thyroid function testing, and complete clinical assessment. These included the determination of the erythrocyte sedimentation rate as well as the level of TSH, free triiodothyronine, free thyroxine, total triiodothyronine level, total thyroxine level, C-reactive protein, rheumatoid factor immunoglobulin (RF-Ig), RF-IgA, RF-IgG, RFIgM, cyclic citrullinated peptide immunoglobulin G (CCP IgG), complement component 3, and complement component 4. Based on these data, thyroid function, and rheumatoid factor levels were analyzed.

Results and Discussion: Curve estimation using linear regression revealed that CCP Ig level was significantly correlated with the TSH level (r = 0.122, P = 0.031).

Conclusion: TSH level may be used as an auxiliary test to assess disease severity in patients with RA and to evaluate thyroid function. This evaluation parameter may be considered for determining clinical prognosis in patients with RA.

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<![CDATA[The Short-term Efficacy of Contrast-enhanced Ultrasound (CEUS) and Gd- EOB-DTPA-enhanced Magnetic Resonance Imaging (MRI) Fusion Imagingguided Radiofrequency Ablation (RFA) for Colorectal Liver Metastasis (CRLM)]]>https://eurekaselect.com/article/1306982024-03-28Objective: This study is to explore the efficacy of contrast-enhanced ultrasound (CEUS) / Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) fusion imaging-guided(fusion group)radiofrequency ablation (RFA) versus conventional ultrasound imaging-guided (conventional group) RFA for colorectal cancer liver metastases (CRLM) in a short-term.

Methods: From December 2020 to December 2021, patients who underwent imaging-guided RFA of CRLM at our hospital with available CT/MRI images were enrolled consecutively. 22 patients with 46 lesions had undergone conventional group RFA whereas 29 patients with 63 lesions had undergone fusion group RFA. The lesion detection rate, technical success, local tumor progression (LTP) and complications were calculated.

Results: In this retrospective study, 51 patients with 130 lesions were diagnosed with CRLM. However, there were 12 lesions and 9 lesions invisible in the conventional group and fusion group, respectively. The lesion detection rate on the fusion imaging was significantly higher than on the US or CEUS in the fusion group (P<0.05). There were no significant differences of the detection rate between the conventional group and the fusion group (P=0.207). In both groups, the technical success rate was 100%. For local tumor progression (LTP), there were no significant differences between the two groups (P>0.05). The complications after ablation had no significant differences between the two groups (P=0.97).

Conclusion: CEUS/ Gd-EOB-DTPA-enhanced MRI fusion imaging is a safe and effective method for RFA in the management of CRLM patients, and it may improve the therapeutic effect by detecting small lesions early.

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<![CDATA[Computer-aided Diagnosis of Various Diseases Using Ultrasonography Images]]>https://eurekaselect.com/article/1300032024-03-28 <![CDATA[Current Trends in Feature Extraction and Classification Methodologies of Biomedical Signals]]>https://eurekaselect.com/article/1300732024-03-28 <![CDATA[Computer-aided Diagnosis and Analysis of Skin Cancer from Dermoscopic Images in India]]>https://eurekaselect.com/article/1308122024-03-28Background: Researchers have made several advancements in this field, including automatic segmentation techniques, computer-aided diagnosis, mobile-based technology, deep learning methods, hybrid methods etc. All these techniques are beneficial in diagnosing melanoma or segregating skin lesions into different categories.

Aim: This paper aims to define different types of skin cancers, diagnosis procedures and statistics. This paper presents skin cancer statistics over a period of time in India. The increment in the number of skin carcinoma and melanoma cases from 1990 to 2020 as well as the mortality rates, has been presented in this paper. Also, this paper provides a review of different technologies used by researchers in detecting melanoma.

Conclusion: The rise in the number of cases by 2040 and mortality rates are compared. The statistics that are used in this paper are as per hospital-based cancer registries (HBCR) 2021 prepared by the Indian Council of Medical Research - National Centre for Disease Informatics and Research, Bengaluru (ICMR-NCDIR) and from World Health Organization (WHO).

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<![CDATA[Reversible Intracranial Cytotoxic Edema Associated with COVID-19: A Case Report]]>https://eurekaselect.com/article/1317722024-03-28Background: It is well-known that COVID-19 causes pneumonia and acute respiratory distress syndrome, as well as pathological neuroradiological imaging findings and various neurological symptoms associated with them. These include a range of neurological diseases, such as acute cerebrovascular diseases, encephalopathy, meningitis, encephalitis, epilepsy, cerebral vein thrombosis, and polyneuropathies. Herein, we report a case of reversible intracranial cytotoxic edema due to COVID-19, who fully recovered clinically and radiologically.

Case Report: A 24-year-old male patient presented with a speech disorder and numbness in his hands and tongue, which developed after flu-like symptoms. An appearance compatible with COVID-19 pneumonia was detected in thorax computed tomography. Delta variant (L452R) was positive in the COVID reverse-transcriptase polymerase chain reaction test (RT-PCR). Cranial radiological imaging revealed intracranial cytotoxic edema, which was thought to be related to COVID-19. Apparent diffusion coefficient (ADC) measurement values in the magnetic resonance imaging (MRI) taken on admission were 228 mm2/sec in the splenium and 151 mm2/sec in the genu. During the follow-up visits of the patient, epileptic seizures developed due to intracranial cytotoxic edema. ADC measurement values in the MRI taken on the 5th day of the patient's symptoms were 232 mm2/sec in the splenium and 153 mm2/sec in the genu. ADC measurement values in the MRI taken on the 15th day were 832 mm2/sec in the splenium and 887 mm2/sec in the genu. He was discharged from the hospital on the 15th day of his complaint with a clinical and radiological complete recovery.

Conclusion: Abnormal neuroimaging findings caused by COVID-19 are quite common. Although not specific to COVID-19, cerebral cytotoxic edema is one of these neuroimaging findings. ADC measurement values are significant for planning follow-up and treatment options. Changes in ADC values in repeated measurements can guide clinicians about the development of suspected cytotoxic lesions. Therefore, clinicians should approach cases of COVID-19 with CNS involvement without extensive systemic involvement with caution.

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<![CDATA[MLP-Res-Unet: MLPs and Residual Blocks-based U-shaped Network Intervertebral Disc Segmentation of Multi-modal MR Spine Images]]>https://eurekaselect.com/article/1309542024-03-28Background: Intervertebral disc degeneration (IVD) is now the most prevalent disease in the world; thus, precise intervertebral disc segmentation is essential for the assessment and diagnosis of spinal diseases. Multi-modal magnetic resonance (MR) imaging is more multi-dimensional and thorough than unimodal imaging. However, manual segmentation of multi-modal MRI not only imposes a huge burden on physicians but also has a high error rate.

Objective: In this study, we propose a new method that can efficiently and accurately segment intervertebral discs from multi-modal MR spine images, providing a reproducible usage scheme for the diagnosis of spinal disorders.

Methods: We suggest a network structure called MLP-Res-Unet that reduces the amount of computational load and the number of parameters while maintaining performance. Our contribution is two-fold. First, a medical image segmentation network that fuses residual blocks and a multilayer perceptron (MLP) is proposed. Secondly, we design a new deep supervised method and pass the features extracted from the encoder to the decoder through the residual path to achieve a new full-scale residual connection.

Results: We evaluate the network on the MICCAI-2018 IVD dataset and obtain Dice similarity coefficient equal to 94.77 (%) and Jaccard coefficient equal to 84.74 (%), while we reduce the amount of parameters by a factor of 3.9 and computation by a factor of 2.4 compared to the IVD-Net.

Conclusion: Experiments show that MLP-Res-Unet improves segmentation performance and creates a simpler model structure while reducing the number of parameters and computation.

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<![CDATA[Diagnostic Performance of Deep Learning in Screened Mammogram: Systematic Review]]>https://eurekaselect.com/article/1309842024-03-28Background: The usage of artificial intelligence in medical image analysis has significantly surpassed that of earlier related technologies. This paper aimed to investigate the diagnostic accuracy of Artificial Intelligence (AI) based-deep learning models for breast cancer detection.

Methods: We used the PICO (Patient/Population/Problem, Intervention, Comparison, Outcome) scheme to formulate the research question and construct our search terms. Studies were systematically examined from the available literature using the constructed search terms from PubMed, and ScienceDirect according to the PRISMA guidelines. The quality of the included studies was assessed using the QUADAS-2 checklist. The characteristics of each included study such as the study design, population, index test, and reference standard, were extracted. The sensitivity, specificity, and AUC for each study were also reported.

Results: In this systematic review, 14 studies were analyzed. Eight studies showed that AI was more accurate than radiologists in evaluating mammographic images, while one comprehensive study found AI to be less precise. Studies that reported sensitivity and specificity without radiologist intervention showed performance scores ranging from 16.0% to 89.71%. With radiologist intervention, sensitivity was between 62% to 86%. Only three studies reported a specificity of 73.5% to 79%. The AUC of the studies was between 0.79 and 0.95. Thirteen studies were retrospective, and one was prospective.

Conclusion: There's inadequate evidence on the effectiveness of AI-based deep learning for breast cancer screening in clinical settings. More research is needed, including studies evaluating accuracy, RCTs, and large-scale cohort studies. This systematic review found that AI-based deep learning improves radiologists' accuracy, especially for novice radiologists. Younger, tech-savvy clinicians may be more accepting of AI. Although it can't replace radiologists, the encouraging results suggest it will play a significant role in identifying breast cancer in the future.

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<![CDATA[Clinical Application of Individualized 3D-Printed Chest Wall Conformal Device in IMRT for Post-mastectomy Breast Cancer]]>https://eurekaselect.com/article/1296892024-03-28Background: Breast cancer is the most common malignant tumour in women. Radical mastectomy with postoperative radiotherapy is now the standard treatment for locally advanced breast cancer. Intensity-modulated radiotherapy (IMRT) has now been developed, which employs linear accelerators to deliver precise radiation to a tumour while minimizing the dose to surrounding normal tissue. It significantly improves the efficacy of breast cancer treatment. However, there are still some flaws that must be addressed.

Objective: To assess the clinical application of the three-dimensional (3D)-printed chest wall conformal device for breast cancer patients who need to be treated by chest wall intensity modulated radiotherapy (IMRT) after radical mastectomy.

Methods: The 24 patients were divided into three groups. During a computed tomography (CT) scan, patients in the study group were fixed by a 3D-printed chest wall conformal device, nothing in control group A, and a traditional 1-cm thick silica gel compensatory pad on the chest wall in control group B. The parameters of mean Dmax, Dmean, D2%, D50%, D98%, the conformity index (CI), and the homogeneity index (HI) of the planning target volume (PTV) are compared.

Results: The study group had the best dose uniformity (HI = 0.092) and the highest conformation (CI = 0.97), the worst in control group A (HI = 0.304, CI = 0.84). The mean Dmax, Dmean, and D2% of the study group were lower than control groups A and B (p<0.05). The mean D50% was higher than control group B (p<0.05), while the mean D98% was higher than control groups A and B (p<0.05). The mean Dmax, Dmean, D2%, and HI of control group A were higher than control group B (p<0.05), whereas the mean D98% and CI were lower than control group B (p<0.05).

Conclusion: By improving the efficacy of postoperative radiotherapy for breast cancer, using 3D-printed chest wall conformal devices may greatly improve the accuracy of repeating position fixation, increase the dose on the skin surface of the chest wall, optimise the dose distribution of the target area, and thus further reduce tumour recurrence and prolong patients' survival.

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<![CDATA[Application of Transabdominal Ultrasonography in the Diagnosis of Absent Contractility - A Case Report]]>https://eurekaselect.com/article/1303152024-03-28Introduction: Absent contractility is a kind of esophageal motility disorder. Patients are often diagnosed by endoscopic ultrasonography or high-resolution manometry (HRM). In this paper, we report two cases of absent esophageal contractility first discovered by transabdominal ultrasonography.

Case Presentation: The main symptom of both cases was acid reflux, and the main diagnosis was absent esophageal contractility. They were all discovered by transabdominal ultrasonography. After the treatment of surgery or drugs, the symptoms relieved during follow-up, without any other discomforts.

Conclusion: Transabdominal ultrasound as a primary screening method for absent contractility is proposed in this paper, which is non-invasive, real-time, and fast. Ultrasound is expected to improve the diagnostic efficiency of peristalsis and patient experience in combination with the above invasive examinations. The use of sonography in the diagnosis of absent contractility has seldom been studied. Further investigation is required to determine whether this technique may better assess absent contractility.

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<![CDATA[Rarer Components of a Rare Disease: Accessory Hemidiaphragm and Horseshoe Lung with Scimitar Syndrome: Two Case Reports]]>https://eurekaselect.com/article/1303162024-03-28Introduction: Scimitar syndrome is a rare developmental anomaly with an incidence of 2/100.000 births. Major components of this disease are partial anomalous pulmonary venous drainage, pulmonary hypoplasia, systemic arterialization of the right basal lung, and dextroposition of the heart. Horseshoe lung and accessory hemidiaphragm are two rarer components of this disease.

Case Presentation: In this paper, horseshoe lung and accessory diaphragm associated with Scimitar syndrome have been reported in two cases.

Conclusion: In conclusion, being aware of rare manifestations of rare diseases is important to fully describe the pathologic spectrum of the disease. This will assist in better management and decision-making process.

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<![CDATA[Huge Primary Clear Cell Hepatocellular Carcinoma: A Case Report and Review of Radiologic Findings]]>https://eurekaselect.com/article/1319862024-03-28Introduction: Clear cell hepatocellular carcinoma (HCC) is a rare subtype of HCC. Histologically, clear cell HCC is characterized by the cytoplasmic accumulation of glycogen with a clear cell appearance, constituting > 80% of tumor cells. Radiologically, clear cell HCC demonstrates early enhancement and washout similar to conventional HCC. Occasionally, enhancing capsule and intratumoral fat are accompanied by clear cell HCC.

Case Description: A 57-year-old male presented to our hospital with right upper quadrant abdominal pain. Ultrasonography, computed tomography, and magnetic resonance imaging revealed a large mass with a well-defined margin in the right hemiliver. The patient underwent a right hemihepatectomy, and the final histopathology revealed clear cell-type HCC.

Conclusion: Distinguishing clear cell types from other types of HCC solely based on radiological findings is challenging. If hepatic tumors exhibit encapsulated margins, enhancing rims, intratumoral fat, and arterial phase hyperenhancement/washout pattern despite their large size, consideration of clear cell subtypes in the differential diagnosis list will aid patient management, implying better prognosis than not-otherwise-specified HCC.

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<![CDATA[Correlation of Diffusion weighted MR Imaging and ADC Values of Hepatic Metastasis of Gastrointestinal Stromal and Gastroenteropancreatic Neuroendocrine Tumors]]>https://eurekaselect.com/article/1319962024-03-28Background: DWI and ADC-mapping was performed to analyze hepatic metastasis of GIST, GEP-NET.

Objective: The objective of this study is to present hepatic metastasis of GIST and GEP-NET with Diffusion weighted MR imaging(DWI) and the Apparent diffusion coefficients (ADC) values of masses.

Methods: 18 GIST patients and 8 GEP-NET patients were examined retrospectively. 11 males and 6 females were present in GIST group, 7 males to 5 females were involved in GEP-NET group. 18 primary GIST and 10 hepatic metastasis of GIST, 8 original GEP-NET and 19 hepatic metastasis of GEP-NET; total 55 GIST and GEP-NET masses were analysed by ADC mapping. MR images were acquired by 1,5 T MR units (32 mT/min gradient strength- Achieva; Philips Healthcare, Best, Netherlands and 32 channel GE Signa GE-Wisconsin-USA); by using a 4-8 channel standard phased-array torso XL coil, all images were evaluated by an Abdominal MRI experienced radiologist. DWI was performed in the transverse plane by using spin-echo-planar imaging sequence.

Results: No statistical differences were observed between GIST and GEP-NET patients according to age and gender variations. No significant statistical differences were observed according to the diameters and ADC values of GIST and GEP-NET patients. A significant statistical difference was observed between GIST and GEP-NET groups in terms of size of liver metastasis which was significantly higher in GIST patients. All three groups (GIST_Hep. MET, GEP-NET_Liver_Met and normal) were statistically differed according to ADC values. With the ROC curve analysis: Hepatic metastasis of GIST(n=10) and normal liver (n:47) had cut-off value for ADC: 0.925 under AUC: 0.939 with regard to ADC values and regarded 89.4% Sensitivity, 100% Specificity, 100% PPV and 66.7% PPV. ROC curve of GEP NET_ Hepatic metastasis (n=19) group and normal liver (n:47) group presented cut-off value for ADC: 0.860 under AUC: 0.967 correlated to ADC values with 93.6% sensitivity, 89.5% specificity, 95.7% PPV and 85% PPV.

Conclusion: High cellular tumors resulted from liver metastasis of GIST and GEP-NET’s, and a positive correlation was observed between ADC values and cellularity/differentiation ratios of metastatic masses.

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<![CDATA[Objective Evaluation of Oral and Pharyngeal Areas in Autopsy Cases of Obstructive Sleep Apnea Syndrome <i>via</i> Postmortem CT]]>https://eurekaselect.com/article/1303812024-03-28Background: Obstructive sleep apnea syndrome (OSAS) can cause sudden death during sleep. Previous findings have suggested that OSAS development is related to maxillofacial morphology. Evaluation of facial morphology can determine the risk of developing the disease, and establishing an objective method to assess the underlying etiology of OSAS-related death would be advantageous.

Objective: The objective of this study is to determine the key features of obstructive sleep apnea syndrome (OSAS) using postmortem oral and pharyngeal computed tomography (CT).

Methods: We retrospectively assessed autopsy cases of patients with (n=25) and without (n=25) OSAS-related death. We used oral and pharyngeal CT images to compare the oral and pharyngeal cavity volume (OPCV), oral and pharyngeal soft tissue volume (OPSV), oral and pharyngeal air space volume (OPAV), and OPAV to OPCV ratio (%air). Receiver operating curve (ROC) analysis was used to determine the accuracy of OSAS prediction. We assessed participants with body mass index (BMI) values within the normal range.

Results: Among the 50 subjects, we observed significant between-group differences in OPSV, OPAV, and % air, whereas there were significant betweengroup differences in OPSV and %air among 28 subjects with normal BMI values. Both comparisons suggested that OSAS-related death was associated with low %air and high OPSV values.

Conclusion: The % air and OPSV are useful for assessing postmortem oropharyngeal CT images. OSAS-related sudden death is likely when %air and OPSV values are ≤20.1% and ≥127.2 ml, respectively. Among those with normal BMI values, % air and OPSV values of ≤22.8% and ≥111.5 ml, respectively, predict OSAS-related sudden death.

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<![CDATA[Application of Deep Learning in the Diagnosis of Alzheimer’s and Parkinson’s Disease: A Review]]>https://eurekaselect.com/article/1303962024-03-28 <![CDATA[Clinical Value of Deep Vein Thrombosis Density on Lower-Extremity CT Venography: Prediction of Pulmonary Thromboembolism]]>https://eurekaselect.com/article/1306992024-03-28Aim: Diagnosis of pulmonary thromboembolism (PTE) can be delayed if the signs and symptoms of patients are nonspecific.

Introduction: To assess the clinical value of deep vein thrombosis (DVT) density on computed tomography (CT) venography for predicting PTE.

Methods: From 2016 to 2021, patients with DVT diagnosed on lower-extremity CT venography were included. Of these patients, those without PTE were classified into ‘DVT-only group’ and those with PTE were classified into the ‘DVT with PTE group’. The DVT Hounsfield unit (HU) density was measured by drawing free-hand region-of-interests within the thrombus at the most proximal filling defect level. The risk factors associated with PTE were identified by using multivariate logistic regression analysis. A receiver operating characteristic (ROC) analysis was used to evaluate the value of DVT density for predicting the risk of PTE.

Results and Discussion: This study included 177 patients with a mean age of 41.7 ± 10.3 years (DVT-only group: 105 patients; DVT with PTE group: 72 patients). DVT density was significantly higher in DVT with the PTE group than DVT-only group (66.8HU ± 8.7 vs. 57.9HU ± 11.1, p < 0.001). The ROC analysis revealed that the area under the curve (AUC), sensitivity, and specificity for predicting the risk of PTE were 0.737, 72.2%, and 66.7%, respectively, at a DVT density cutoff of 63.0 HU. On univariate and multivariate analysis, DVT density was the only significant risk factor associated with PTE.

Conclusion: Higher DVT density was a significant risk factor for PTE. In addition, DVT density could be a predictive factor for PTE.

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<![CDATA[Computer Tomography (CT)-based Screening of Hospitalized Patients with Chronic Obstructive Pulmonary Disease Complicated by Bronchiectasis Phenotype during Acute Exacerbation: A Clinical Analysis]]>https://eurekaselect.com/article/1315782024-03-28Background: In the past, many experts considered chronic obstructive pulmonary disease (COPD) and bronchiectasis to be separate, chronic respiratory diseases. Nonetheless, the widespread use of high-resolution lung computed tomography (CT) has led to the discovery that these diseases can occur alone or together.

Aim: The current study aimed to compare the effects of nutritional status on the clinical outcomes in moderate to severe COPD patients with bronchiectasis.

Objective: This study identifies the nutritional risk in hospitalized patients with moderate to severe COPD complicated by bronchiectasis phenotype during acute exacerbation screened using computer tomography (CT). Also, determines its correlation with disease progression.

Materials and Methods: NRS 2002 (Nutrition Risk Screening Evaluation Tool) was used to determine and evaluate the nutritional risk status in 182 hospitalized patients with moderate to severe COPD complicated by bronchiectasis phenotype during an acute exacerbation. Selected patients were divided into the nutritional risk (NR) group and the non-nutritional risk (NNR) group according to their nutritional status determined by NRS 2002. The body mass index (BMI), serum albumin (ALB), pre albumin (PAB), lymphocyte count (TLC), FEV1/FVC, FEV1% predicted, PEF% predicted, blood gas analysis, number of acute exacerbations in the past year, number of respiratory failure cases, number of anti-infection days, and length of hospitalization of the two groups were observed.

Results: The hospitalized patients in acute exacerbation of moderate to severe COPD complicated by bronchiectasis phenotype had a nutritional risk of 62.64%. BMI, ALB, PAB, TLC, FEV1% predicted, FEV1/FVC, PEF% predicted, blood gas analysis, number of acute exacerbations in the past year, number of respiratory failure cases, number of anti-infection days, and length of hospitalization were statistically significantly different between the NR group and NNR group (P<0.05).

Conclusion: Hospitalized patients with moderate to severe COPD complicated by bronchiectasis phenotype during acute exacerbation are often associated with nutritional risk. An increase in nutritional risk reduces the level of pulmonary function of the patient and elevates the risk for repeated acute exacerbations, which predispose the patient to respiratory failure, thereby increasing the length of hospitalization. Therefore, the nutritional risk status of COPD patients with bronchiectasis was closely related to the occurrence, development, and prognosis of the disease.

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<![CDATA[Advances in Imaging Techniques of the Blood-brain Barrier and Clinical Application]]>https://eurekaselect.com/article/1313222024-03-28 <![CDATA[Fibrosarcoma of Great Toe with Multimodality Radiologic Imaging Features]]>https://eurekaselect.com/article/1328362024-03-28Introduction: Fibrosarcoma of bone is a rare malignant spindle cell tumor.

Case Study: Herein, we present a case of fibrosarcoma in a 40-year-old male who was presented to the clinic with left-sided great toe pain for 20 years. Simple radiographs showed acrolysis at the distal phalanx of great toe. Magnetic resonance imaging (MRI) revealed a 1.5 cm sized heterogenous high signal intensity mass on T2-weighted images and iso signal intensity on T1- weighted images. Dorsal and distal portion of the mass showed markedly dark signal intensity on T1 and T2-weighted images.

Conclusion: In an enhanced image, the mass showed heterogenous enhancement. Surgical removal was performed and pathologic analysis revealed fibrosarcoma. Although extremely rare, fibrosarcoma of the bone should be kept in mind as a possibility when a lesion exhibits a black signal intensity component on an MRI with acrolysis.

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<![CDATA[Objective Value of the Apparent Diffusion Coefficient (ADC) Map from Ultrahigh b-value Diffusion-weighted Imaging (DWI) in 3T MRI could be a Non-invasive Specific Biomarker for Prostate Cancer]]>https://eurekaselect.com/article/1329802024-03-28Objective: This article aims to explore the ADC value of ultrahigh b-value DWI and the diagnostic cutoff point in prostate cancer.

Methods: A total of 78 patients were included in this study. T2 weighted imaging (T2WI), conventional diffusion-weighted imaging (DWI) (1000 s/mm2), and DWI with ultrahigh b-values of 2000 s/mm2 and 3000 s/mm2 were performed in each patient. With reference biopsy as the gold standard, the apparent diffusion coefficient (ADC)s of each b-value DWI image were analyzed. According to different b-value receiver operating characteristic (ROC) curves, the ADC diagnostic cutoff point for prostate cancer was determined.

Results: A total of 154 lesions were identified as prostate cancer. The ADC values for conventional DWI and ultrahigh b-value DWI with 2000 s/mm2 and 3000 s/mm2 were 1.097×10-3 mm2/s (1.040-1.153), 0.809×10-3 mm2/s (0.766-0.851) and 0.622×10-3 mm2/s (0.591-0.652), respectively, in the peripheral zone and 1.085×10-3 mm2/s (1.022-1.147), 0.815×10-3 mm2/s (0.770-0.861) and 0.651×10-3 mm2/s (0.617-0.685) in the transition zone. The area under the curve (AUC)s of the ADC values from ultrahigh b-value DWI (2000 s/mm2 and 3000 s/mm2) were 0.824 and 0.852 in the peripheral zone and 0.905 for the ADC values from ultrahigh b-value DWI (3000 s/mm2) in the transition zone. In the peripheral zone, the ADC diagnostic cutoff values for prostate cancer were 0.75×10-3 mm2/s and 0.685×10-3 mm2/s in DWI at 2000 s/mm2 and 3000 s/mm2, respectively, and the diagnosis of transition zone cancer was 0.8×10-3 mm2/s and 0.634×10-3 mm2/s, respectively.

Conclusion: The ADC values from ultrahigh b-value DWI demonstrated better consistency and diagnostic efficacy in the diagnosis of prostate cancer.

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<![CDATA[Ultrasound Diagnosis of Renal Cell Carcinoma associated with Xp11.2 Translocation/TFE3 Gene Fusion in Children and Adolescents]]>https://eurekaselect.com/article/1330292024-03-28Background: Many studies have reported Xp 11.2 translocation renal cancer in radioimaging,but there is little literature on the evaluation of Xp11.2 translocation renal cell carcinoma by ultrasound.

Objective: To investigate the ultrasonographic features and diagnostic value of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion in children and adolescents.

Materials and Methods: The clinical and ultrasonographic data of 10 patients with renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion confirmed by pathology in our hospital were analyzed retrospectively. The age ranged from 3 to 18 years old, including 7 males and 3 females. The tumor location, size, boundary, echo, hemorrhage, cystic change, calcification, blood flow, lymph node status and metastasis were mainly observed, and the results were compared with the pathological results.

Results: There were 10 masses in 10 cases of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion, including 4 in the right kidney and 6 in the left kidney; the maximum diameter line is 5-23cm; 9 cases had clear mass boundary (90%); 9 masses (90%) showed mixed cystic and solid masses with high echo of solid components, and 1 mass (10%) showed huge multilocular cystic mass with multiple septations; necrosis and cystic changes were seen in all 10 masses (100%); calcification in 5 masses (50%); blood flow signals were seen in the solid components of the mass (100%).

Conclusion: Renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion in children and adolescents are mostly large cystic and solid mixed echo masses, with high echo of solid components, and often accompanied by cystic changes and calcification. Its ultrasonic manifestations have certain characteristics. Color Doppler ultrasound has a certain diagnostic value for this disease.

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<![CDATA[Does Bi-exponential Fitting Perform better than Mono-exponential Fitting in IVIM-DWI? An Assessment of Renal Pathological Injury of IgA Nephropathy]]>https://eurekaselect.com/article/1326992024-03-28Background: Chronic kidney disease has become one of the world's major public health problems, immunoglobulin A (IgA) nephropathy is a common pathological type of CKD. Delaying the progression of IgA nephropathy has currently become the main clinical treatment strategy, precise evaluation of renal pathological injury during follow-up of patients with IgA nephropathy is important. Therefore, it is imperative to develop an accurate and non-invasive imaging technique for effective follow-up of renal pathological injury in patients with IgA nephropathy.

Objective: To investigate the clinical value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in assessing renal pathological injury in patients with immunoglobulin A (IgA) nephropathy compared with a mono-exponential model.

Methods: Altogether, 80 patients with IgA nephropathy were divided into the mild (41 cases) andmoderate–severe (m–s) renal injury groups (39 cases) according to pathology scores, and 20 healthy volunteers were recruited as controls. All participants underwent IVIM-DWI of the kidneys, and renal parenchymal apparent diffusion coefficient (ADC), pure molecular diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) values were measured. One-way analysis of variance, receiver operating characteristic (ROC) curve analysis, and Pearson correlation analysis were performed for all the DWI-derived parameters.

Results: The DWI-derived parameters of the m–s renal injury group were significantly lower than those of the mild renal injury and control groups (P < 0.01). The ROC analysis revealed that f had the largest area under the ROC curve for differentiation between the m–s and mild renal injury groups and between the m–s renal injury and control groups. The f had the largest correlation coefficient with renal pathology scores (r=−0.81), followed by the D* (−0.69), ADC (−0.54), and D values (−0.53), respectively (all P<0.01).

Conclusion: IVIM-DWI demonstrated better diagnostic performance than the mono-exponential model in assessing renal pathological injury in patients with IgA nephropathy.

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<![CDATA[Acute Mesenteric Ischemia: The Diagnostic Value of QT Parameters and their Relationship with CT Findings]]>https://eurekaselect.com/article/1272512024-03-28Background: One of the greatest challenges in the diagnosis of acute mesenteric ischemia (AMI) is the lack of specific laboratory tests that support multidetector computed tomography (CT). Our aim is to investigate the diagnostic value of electrocardiographic QT parameters in AMI and their relationship with CT findings.

Materials and Methods: Patients who were admitted to the emergency department with abdominal pain were recruited retrospectively from the hospital information system. Grouping was carried out on the basis of AMI (n=78) and non-AMI (n=78). In both groups, the corrected QT (QTc) and QT dispersion (QTD) were measured on electrocardiographs, and the qualitative and quantitative CT findings were evaluated on CT examinations.

Results: The QTc and QTD values were higher in the AMI group. The median QTc values were 456.16 (IQR: 422.88-483.16) for the AMI group and 388.83 (IQR: 359.74-415.83) for the control group (p<0.001), and the median QTD values were 58 (IQR: 50.3-68.25) for the AMI group and 46 (IQR: 42-50) for the control group (p<0.001).

In the CT analysis, the QTc values were significantly higher among AMI patients, with images of paper-thin bowel walls and the absence of bowel wall enhancement (p=0.042 and p=0.042, respectively). Meanwhile, the QTD values were significantly higher among patients with venous pneumatosis findings on CT (p=0.005). In the regression analysis, a significant relationship was found between the QT parameters and AMI (p<0.001). For QTc, an AUC of 0.903 (95% CI: 0.857-0.950, p<0.001), a sensitivity of 80.8%, and a specificity of 82.3% were found. For QTD, an AUC of 0.821 (95% CI: 0.753-0.889, p<0.001), a sensitivity of 73.1%, and a specificity of 82.3% were found.

Conclusion: We found the QTc and QTD values to be significantly higher among AMI patients. Furthermore, we found a significant relationship between the CT findings and QTc and QTD and a significant relationship between survival and QTc in the AMI group.

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<![CDATA[Hounsfield Unit Variations-based Liver Lesions Detection and Classification using Deep Learning]]>https://eurekaselect.com/article/1313262024-03-28Background: Deep learning-based diagnosis systems are useful to identify abnormalities in medical images with the greatly increased workload of doctors. Specifically, the rate of new cases and deaths from malignancies is rising for liver diseases. Early detection of liver lesions plays an extremely important role in effective treatment and gives a higher chance of survival for patients. Therefore, automatic detection and classification of common liver lesions are essential for doctors. In fact, radiologists mainly rely on Hounsfield Units to locate liver lesions but previous studies often pay little attention to this factor.

Methods: In this paper, we propose an improved method for the automatic classification of common liver lesions based on deep learning techniques and the variation of Hounsfield Unit densities on CT images with and without contrast. Hounsfield Unit is used to locate liver lesions accurately and support data labeling for classification. We construct a multi-phase classification model developed on the deep neural networks of Faster R-CNN, R-FCN, SSD, and Mask R-CNN with the transfer learning approach.

Results: The experiments are conducted on six scenarios with multi-phase CT images of common liver lesions. Experimental results show that the proposed method improves the detection and classification of liver lesions compared with recent methods because its accuracy achieves up to 97.4%.

Conclusion: The proposed models are very useful to assist doctors in the automatic segmentation and classification of liver lesions to solve the problem of depending on the clinician’s experience in the diagnosis and treatment of liver lesions.

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<![CDATA[An Empirical Selection of Wavelet for Near-lossless Medical Image Compression]]>https://eurekaselect.com/article/1305382024-03-28 <![CDATA[Comparative Analysis of Ultrasound Diagnosis and Pathological Characteristics of External Jugular Venous Aneurysm]]>https://eurekaselect.com/article/1328982024-03-28Purpose: This study aimed to investigate the diagnosis of the external jugular venous aneurysm on color Doppler ultrasound and its relationship with pathological characteristics.

Methods: A retrospective analysis of 17 patients with external jugular venous aneurysm admitted to the Provincial Hospital Affiliated with Shandong First Medical University from May, 2010, to June, 2020, was performed. The color Doppler ultrasound characteristics of 17 patients with external jugular vein aneurysms were analyzed and summarized, which were then compared with postoperative pathological outcomes.

Results: All 17 patients with external jugular venous aneurysms were presented with cystic structures adjacent to and communicated with the external jugular vein. Color Doppler flow imaging showed a bidirectional venous flow signal in the communication between the cystic structure and the external jugular vein. Among the 17 patients, ultrasound diagnosis showed true venous aneurysm due to degenerative changes in the venous wall in 8 cases, venous pseudoaneurysm in 4 cases, and external jugular venous aneurysm in 5 cases, and postoperative pathology indicated degenerative changes in the venous wall in all 17 patients.

Conclusion: Bidirectional blood flow at the communication between the cystic lesion and the external jugular vein on color Doppler ultrasound should not be the criterion for the diagnosis of external jugular venous pseudoaneurysm, which requires pathological support.

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<![CDATA[Nontuberculous Mycobacterial Infection Mimicking Lung Cancer in a Patient with Usual Interstitial Pneumonia Pattern Interstitial Lung Disease: A Case Report]]>https://eurekaselect.com/article/1330992024-03-28Background: It has been reported that structure damage in the parenchymal lung disease such as idiopathic pulmonary fibrosis (IPF) is associated with high susceptibility to nontuberculous mycobacterial (NTM) infection. Radiologic features of NTM lung disease in destructive lung parenchyma can be atypical, which can cause confusion with other diseases including malignancy. Prompt and accurate identification of newly developed lesions in the follow-up computed tomography (CT) of IPF patients is challenging but crucial.

Case Report: We reported a case of an NTM infection in a patient with IPF, manifested as a mass-like consolidation with cavitation on chest CT, mimicking lung cancer.

Conclusion: Being aware of the unusual radiologic features of NTM lung disease in IPF patients can be useful in the differential diagnosis of newly detected lesions.

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<![CDATA[Multi-slice CT Analysis and Identification of Anatomical Types of Segmental Bronchi in Right Superior Lobe]]>https://eurekaselect.com/article/1330322024-03-28Purpose: The aims were to assess different branching patterns of segmental bronchi in the right superior lobe (RSL), as well as to investigate the anatomical diversity and sex-related variations of these branches in a large sample of the research population.

Methods: 10,000 participants (5428 males, and 4,572 females, mean age 50+/-13.5 years [SD] years; age range: 3-91 years) who underwent multi-slice CT (MSCT) scans from September 2019 to December 2021 were retrospectively included. The data were applied to generate three-dimensional (3D) and virtual bronchoscopy (VB) simulations of a bronchial tree using the syngo.via post-processing workstation. Following that, the reconstructed images were interpreted to identify and categorize various bronchial patterns in the RSL. Cross-tabulation analysis and the Pearson chi-square test (χ2) were used to calculate the component ratios of bronchial branch types and determine their relevance between male and female groups.

Results: Our results revealed mainly six types for the RSL bronchial tree, i.e., (B1, B2, B3, 60.70%); (B1+2, B3, 18.72%); (B2+3, B1, 6.68%); (B1+3, B2, 7.57%); (B1, B2, B3, B*, 3.19%); (B1a+B3, B1b+B2, 3.14%). There were significant sex-related differences in the proportion of bronchial branches in the RSL (P< 0.05).

Conclusion: The current study has validated the presence of segmental bronchial variations in the RSL. These findings may have significant implications for diagnosing symptomatic patients and performing particular procedures, including bronchoscopy, endotracheal intubation, and lung resection.

]]> <![CDATA[Diffusion-weighted MRI at the Late Stage after Radiotherapy for Evaluating Salivary Gland Injury]]>https://eurekaselect.com/article/1333292024-03-28Objective: Salivary gland injury is the main complication of radiotherapy for nasopharyngeal carcinoma (NPC) patients. The purpose of this study was to evaluate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) as a reliable tool to assess salivary gland function in NPC patients after radiotherapy.

Materials and Methods: This study analysed the MR images of 31 NPC patients at different time points within 2-3 years after radiotherapy. The changes in the apparent diffusion coefficient (ADC) and its relationship with radiation dose were analysed.

Results: Both the parotid and submandibular gland ADC values increased significantly 3-6 months after radiotherapy and then decreased gradually. The ADC value of the parotid gland was positively correlated with radiation dose at the late stage (P = 0.012, r = 0.359). The submandibular gland ADC change value (P = 0.035) and change ratio (P = 0.027) of the high radiation dose group were significantly lower than those of the low dose group at the late stage.

Conclusion: The correlation between ADC values of parotid and submandibular glands and the radiation dose indicated that DW-MRI could be helpful in evaluating salivary gland injury after radiotherapy.

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<![CDATA[Non-obstructive CAD and Risk of All-cause Mortality in Middle-aged and Older Patients: A Nine-year Follow-up and Multicentre Study]]>https://eurekaselect.com/article/1326072024-03-28Aim: We aimed to examine all-cause mortality risk in relation to the extent of non-obstructive coronary artery disease (CAD) by coronary computed tomography angiography (CTA) in Chinese middle-aged and older patients in a multicenter study with nine-year follow-up.

Methods: This was a retrospective, observational, multicentre study. The study population consisted of 3,240 consecutive middle-aged and older patients (age ≥ 40 years) with suspected CAD who underwent coronary CTA between June 2011 and December 2013 at three hospitals in Wuhan, China. Patients were grouped according to CAD extent for the final analysis: no CAD, 1-vessel non-obstructive CAD, 2-vessels non-obstructive CAD, and 3-vessels non-obstructive CAD. The primary endpoint was all-cause mortality. Kaplan-Meier method and Cox proportional hazards regression models were used for analysis.

Results: A total of 2,522 patients were included in the present analysis. Of these, 188 (7.5%) deaths occurred during the median 9.0 years (interquartile range 8.6–9.4) of study follow-up. The annualized all-cause mortality rate was 0.54 (95% CI: 0.44–0.68), 0.91 (95% CI: 0.68–1.21), 1.44 (95% CI: 1.01–1.93), and 2.00 (95% CI: 1.46–2.69) for the no CAD, 1-vessel non-obstructive CAD, 2-vessels non-obstructive CAD, and 3-vessels nonobstructive CAD group, respectively. Kaplan–Meier survival curves showed a significant increase in the cumulative events associated with the extent of non-obstructive CAD (P < 0.001). In multivariate Cox regression, after adjustment for age and sex, the presence of 3-vessels nonobstructive CAD was a significant predictor of all-cause mortality (HR 1.60, 95% CI: 1.04–2.45, P = 0.032).

Conclusion: In this cohort of Chinese middle-aged and older patients undergoing coronary CTA, the presence and extent of non-obstructive CAD, compared to no CAD, were associated with a significantly greater nine-year risk of all-cause mortality. The present findings suggest the clinical importance of the stage of non-obstructive CAD and warrant investigation of the optimal risk stratification to improve outcomes among these patients.

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<![CDATA[The Role of MRI in Diagnosing Agenesis of the Corpus Callosum (ACC): A Rare Disorder Present at Birth]]>https://eurekaselect.com/article/1327012024-03-28Background: Agenesis of the corpus callosum (ACC) is a rare hereditary nervous system defect present at birth. ACC is an uncommon condition that is unrepresentative in the general population because some cases do not present with any identifiable symptoms in the early stage.

Case Report: We present a case of ACC in a two-month-old male patient who was diagnosed after birth. Although the initial brain ultrasound (US) showed dilation of the lateral ventricles and the absence of the corpus callosum, these findings were not fully confirmed. Therefore, magnetic resonance imaging (MRI) of the brain was conducted to confirm the complex diagnosis, and the examination revealed complete ACC. Diagnosing ACC in a neonate demonstrates the complexity of diagnosis through the clinical presentation, especially at an early age.

Conclusion: The clinical utility of neonatal US and MRI highlights the importance of an early diagnosis of ACC. MRI is more effective than the US in detecting this condition, and these imaging modalities provide the patient with an early diagnosis, which helps in treatment management.

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<![CDATA[Clinical Application of Ultrasound Elastic Imaging in Assessing Poststroke Complex Regional Pain Syndrome (CRPS)]]>https://eurekaselect.com/article/1333092024-03-28Aims: This study aimed to explore the characteristics and clinical application of ultrasonic elastography in peripheral soft tissue in patients with poststroke complex regional pain syndrome (CRPS).

Background: Complex regional pain syndrome (CRPS) type I is also known as shoulder hand syndrome (SHS). Its main symptoms include shoulder pain, limited activity, upper arm, wrist, and knuckle joint pain. Ultrasonic elastic imaging technology is gradually being applied to musculoskeletal system evaluation, primarily for the elastic examination of superficial tissue, as a result of the continual advancements in ultrasound technology. To make up for the absence of conventional imaging, functional state evaluation of the motor system can offer conventional ultrasonic tissue elasticity and hardness data.

Objectives: The purpose of this study was to objectively quantify the soft tissue surrounding the shoulder joint of stroke patients with CRPS using ultrasonic elastic imaging and to determine the diagnostic usefulness of ultrasonic elastic imaging for CRPS in stroke in order to promote its usage in clinical practice.

Materials and Methods: Patients diagnosed with CRPS following a stroke and admitted to the rehabilitation unit at Shanxi Bethune Hospital between January, 2021 to June, 2021 were included in the analysis. The control group consisted of people without pain in their shoulder joints. Each group consisted of 30 patients. A high-frequency wire array probe (frequency = 8-16 Hz) was employed in conjunction with an ultrasonic diagnostic apparatus. A quantitative analytic system determined Young's modulus of the tissue, while the tracking of the shear wave provided an elastin map in real-time. An excitation pulse of acoustic radiation force was used to cause shear waves in the tissue.

Results: The Young's modulus of supraspinatus muscle in the study and control groups was 289.16±22.07 Kpa and 231.99±23.61 Kpa, respectively (P <0.01). Young's modulus values of the study group's subscapular biceps were compared to those of the control group (P > 0.05). The supraspinatus shear wave elastographic (SWE) imaging value was 10.01±0.49 m/s in the study group and 7.92±0.50 in the control group (P <0.05). The study and control groups had subscapular muscle SWE values of 15.99±1.95 and 8.64±0.56 m/s, respectively (P <0.05). The average biceps tendon SWE value in the study and control groups was 6.39±0.42 and 4.69±0.36 m/s, respectively (P <0.05).

Conclusion: In conclusion, the SWE assessed by ultrasound elastography is useful for early diagnosis and evaluation of the superior shoulder tendon, subscapular tendon, and biceps tendon of CRPS following stroke.]]> <![CDATA[MDCT Imaging of Volvulus Complicated with Acute Mesenteric Ischemia Secondary to a Large Diverticulum of Jejunum in an Adult: A Case Report and Literature Review]]>https://eurekaselect.com/article/1334622024-03-28Introduction: A large jejunal diverticulum has been reported as a possible cause of volvulus and acute mesenteric ischemia (AMI) in adults. A large diverticulum of the small bowel complicated with volvulus has been reported before in literature. However, imaging findings of a large diverticulum of the small bowel complicated with both volvulus and AMI on MDCT are rarely described and reported. In this study, we reported a case with a large diverticulum, volvulus, and AMI concurrently; these three imaging findings were reviewed and described on MDCT, and the relevant literature was briefly introduced.

Case Report: We reported the case of a 69-year-old man who presented to our hospital with acute abdominal pain and vomiting. An emergent abdominal enhanced MDCT imaging was performed and demonstrated the volvulus secondary to a large diverticulum of the jejunum complicated with AMI. Here, a case was presented that highlighted unique imaging findings on MDCT, as well as a literature review.

Conclusion: A review of the literature revealed that a single jejunal diverticulum causing both volvulus and AMI is rare in adults. To our knowledge, a systemic description of their signs on MDCT in a case has not been reported yet.

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<![CDATA[Relationship of the Characteristic Imaging Findings of Breast Cancer with Molecular Subtypes in Young Women]]>https://eurekaselect.com/article/1330702024-03-28Background: The characteristic imaging findings of breast cancer in young women are not yet fully understood. It causes a delay in diagnosis by mixing with benign findings.

Objective: To evaluate the relationship between the imaging and histopathological features of breast cancer in women aged under 40 years.

Methods: In our center, 537 suspicious lesions were detected in a total of 15,223 adult female patients under 40 years who were evaluated by breast ultrasonography (US). As a result of the mammographic, histopathological, and immunohistochemical analysis, 101 lesions meeting the study criteria were included in the sample.

Results: The luminal subtypes of breast cancer mostly visualized as irregularly shaped spiculated lesions with calcification and architectural distortion mammography and presented as masses that were sometimes accompanied by increased echogenicity in the surrounding tissue on US. The human epidermal growth factor receptor 2 (HER2) enriched subtypes mostly had microlobulated or indistinct margins with heterogeneous echoes accompanied by high calcification on mammography. The triple-negative (TN) subtypes generally appeared as microlobulated lesions with angular or indistinct margins, hypo echogenicity, posterior enhancement or shadowing, and vascularization.

Conclusion: Some radiological features of breast cancer in young women were found to be associated with molecular subtypes similar to other age groups in the literature. However, unlike other age groups, the incidences of the HER2-enriched subtype presenting with only calcification, TN subtypes presenting with circumscribed masses, and calcification were found to be low among the young women in our study.

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<![CDATA[Diagnostic Value of 3D Optical Coherence Tomography Multimode Images in the Diagnosis of Acute Central Serous Chorioretinopathy]]>https://eurekaselect.com/article/1333772024-03-28Background: Spectral-Domain Optical Coherence Tomography (SD-OCT) provides non-invasive, high-speed, high-resolution, three-dimensional cross-section imaging of the macula.

Objectives: This study aimed to investigate the diagnostic value of the multimodal imaging technique of three-dimension (3D) optical coherence tomography (OCT) (3D-OCT) for the diagnosis and characterization of acute central serous chorioretinopathy (CSC).

Methods: In this prospective clinical study 3D-OCT examinations of 82 cases with acute CSC were performed on the macular area, and the image characteristics were analyzed. Our study included a total of 87 eyes from 82 cases of CSC patients, 67 males and 15 females (mean age ± standard deviation (SD): 42.89 ±7.80 years old; age range: 27 to 56 years old. The 3D-OCT images were evaluated for the presence of subretinal fluid, subretinal space, fluctuation of the internal limiting membrane (ILM), folds of retinal pigment epithelial (RPE), retinal pigment epithelium detachment (PED), and flat irregular PED. The foveal thickness was measured using the manual caliper of OCT software.

Results: The OCT B-scan images showed 87 (100%) eyes had exudative retinal detachment (ERD), 38 (44%) had flat irregular PED, 36 (41%) had PED, 8 (9%) had subretinal turbidity structure, 2 (2%) had subretinal dot-like precipitates, 1 (1%) had focal choroidal excavation (FCE), and 1 (1%) eye had fluctuation of internal limiting membrane (FI). In the ILM-RPE thickness map, all eyes had a round or round like regular uniform domes. Fifty-seven (66%) domes were limited in the examination area and 30 (44%) domes were beyond the scope of this examination and only a partial section of the dome could be observed. In the en-face image, all eyes had a round or round-like black figure that corresponded with domes in the ILM-RPE thickness map. In RPE surface, 76 (87%) eyes had a shallow plate depression, 71(82%) had small focal uplift, and 1 (1%) eye had a focal concave feature.

Conclusion: In the OCT ILM-RPE thickness, en-face image, and RPE surface maps, acute CSC exhibited specific imaging characteristics that can be helpful for reliable diagnosis and differential diagnosis of CSC.

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<![CDATA[Gd-EOB-DTPA-enhanced Magnetic Resonance Imaging Combined with T1 Mapping Identifies Dysplastic Module and Hepatocellular Carcinoma: A Retrospective Study]]>https://eurekaselect.com/article/1334562024-03-28Background: Hepatocellular carcinoma (HCC) is the leading type of liver cancer in adults, often resulting in fatal outcomes for those with cirrhosis. Dysplastic nodule (DN) is a liver nodule that is substantial in size, ranging from 1-2 cm. However, accurately distinguishing between DN and HCC on imaging has posed a challenge.

Objective: The aim of this study is to assess the usefulness of Gd-EOB-DTPA-enhanced MRI T1 mapping in distinguishing between DN and HCC.

Methods: This study analyzed 66 patients with confirmed HCC or DN who underwent Gd-EOB-DTPA-enhanced MRI T1 mapping before surgery or puncture at the Army Medical Center in China. The T1 values of each lesion were measured before and after Gd-EOB-DTPA administration, and various calculations were made, including absolute and percentage reduction in T1 value and coefficient of variation. The t-test was used to compare these values between the two groups, and the efficacy of T1 mapping values for differential diagnosis of HCC and DN was evaluated using the receiver operating characteristic curve (ROC).

Results: The study found that T1pre, T1hp, ΔT1, ΔT1%, and CV in the HCC group were significantly higher than in the DN group (p < 0.01). The accuracy of T1hp, ΔT1, and CVT1-hp in identifying HCC from DN was high, with AUCs of 0.955, 0.910, and 0.932, respectively. ΔT1% also had some accuracy, with an AUC of 0.818.

Conclusion: Our results provide preliminary evidence that Gd-EOB-DTPA-enhanced MRI T1 mapping, can be a valuable tool in diagnosing and differentiating between HCC and DN.

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<![CDATA[Gastric Teratoma in an Adult Female Patient: A Case Report]]>https://eurekaselect.com/article/1338842024-03-28Background: Gastric teratoma (GT) occurs as a rule in infancy and is an extremely unusual gastric tumor in adult patients.

Case Presentation: In this paper, we present the clinical and imaging findings of a 56-year-old female patient with a GT. The patient's main symptoms were increasing abdominal discomfort and pain. After the physical examination, she underwent ultrasound (US) and computed tomography (CT), which showed a large mass at the posterior wall of the stomach, and a teratoma was initially considered. After surgery, pathology confirmed the diagnosis of GT. The patient recovered after surgery and was discharged in good health. To the best of our knowledge, this study is the first reported case of gastric teratoma in an adult woman in the literature.

Conclusion: Gastric teratoma of the adult period is a rare benign neoplasm that may have several complications; therefore, imaging is crucial for diagnosis and accurate treatment management. The aim of this study is to emphasize the value of US and CT in the diagnosis and treatment monitoring of mature gastric teratomas.

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<![CDATA[Intrapancreatic Accessory Spleen Diagnosed by Size Reduction after Immunosuppressive Therapy: A Case Report]]>https://eurekaselect.com/article/1336012024-03-28Background: Intrapancreatic accessory spleen (IPAS) is a congenital entity that can be confused with malignant distal pancreatic masses. Radiologic imaging and radionuclide imaging have an important place in the diagnosis of IPAS.

Case Report: Blood tests were performed on a 36-year-old female patient who presented with tachypnea, tachycardia, pain in the joints, and pain in the left abdominal quadrant. Laboratory test results were as follows: hemoglobin value 6.0 mg/dl, sedimentation 120, aspartate transaminase (AST) 150U/L, and alanine transaminase level (ALT) 110U/ L. Additional laboratory tests and ultrasonography were performed. The anti-doublestranded DNA (dsDNA) level was 800 IU/ml. C3 and C4 values were both 0.64 IU/ml, with anti-Ro-52 +++(three positive) and anti-Ro-60 ++ (two positive). A clinical diagnosis of systemic lupus erythematosus (SLE) was made. Ultrasonography and dynamic contrast-enhanced upper abdominal MRI showed lesions suggestive of multiple hemangiomas in the liver and a 29x18 mm lesion in the tail of the pancreas with a similar appearance as the spleen. SLE treatment was started. Scintigraphy was recommended for the diagnosis of IPAS. Scintigraphy was performed in the third week of the treatment. Uptake was not observed. In the second month of the treatment, a control upper abdominal MRI was performed, and a decrease in the size of the lesion was observed.

Conclusion: IPAS can be confused with pancreatic masses. Lack of uptake in scintigraphy may be due to treatment protocols that produce low phagocytic activity. If radiological imaging findings are compatible, a reduction in lesion size after immunosuppressive therapy can be accepted as evidence for the diagnosis of IPAS.

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<![CDATA[Automated Brain Tumor Detection using Ideal Shallow Neural Network with Artificial Jellyfish Optimization]]>https://eurekaselect.com/article/1332692024-03-28Introduction: Brain tumors are predicted from Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan images. In recent years, image processing-based automated tools are developed to predict tumor areas with less human interference. However, such automated tools are suffering from computational complexity and reduced accuracy in certain critical images. In the proposed work, an Ideal Shallow Neural Network (ISNN) is utilized to improve the prediction accuracy, and the computational complexity is reduced by implementing an Artificial Jellyfish Optimization (AJO) algorithm for minimizing the feature dimensionality.

Methods: The proposed method utilizes MRI images for the verification process as they are more informative than the CT scan image. The BRATS and the Kaggle datasets are used in this work and a Gabor filtering technique is used for noise reduction and a histogram equalization is used for enhancing the tumor boundary regions. The classification results observed from the AJO-ISNN are further forwarded towards the segmentation process and which uses the Centroid Weighted Segmentation (WCS) along with a Grasshopper Optimization Algorithm (GOA) for improving the segmentation over the boundary regions of the brain tumor.

Results: The experimental result indicates a classification accuracy of 95.14% on the proposed AJO-ISNN model and AJO-ISNN is comparatively better than the Convolutional Neural Network (CNN) model accuracy of 85.41% and VGG 19 model accuracy of 93.75% while implemented with the AJO optimization model. Similarly, the Dice Similarity Coefficient of the proposed CWS-GOA also reaches 93.15% when performed with both BRATS and Kaggle datasets.

Conclusion: Apart from the accuracy attainments the proposed work classifies and segments the tumor region in around 65 seconds on average of 200 image verifications and that is comparatively better than the previous multi-cascaded CNN and the InceptionV3 models.

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<![CDATA[Rare and First Manifestation of Lupus Panniculitis as Lupus Mastitis: A Case Report and Literature Review]]>https://eurekaselect.com/article/1333752024-03-28Introduction: This case report presents a rare occurrence of lupus mastitis affecting the breast.

Case Presentation: An induration with mild discomfort was detected in the upper inner quadrant of the right breast of a 27-year-old Chinese woman with regular menstrual cycles. The patient is currently unmarried and has no previous history of full-term pregnancies or lactation. An ill-defined, subcutaneous, hyperechoic lesion with no calcification was visualized on breast ultrasound. Peripheral and internal blood flow signals demonstrated high intensity. Pathological analysis of a breast needle biopsy revealed fat lobule necrosis accompanied by mixed lymphoplasmacytic and histiocytic aggregates.

Conclusion: The diagnosis of lupus mastitis necessitates a comprehensive evaluation of the patient's medical history, serological testing, imaging studies, and histopathological analysis.

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<![CDATA[Orthopantomography <i>Versus</i> Cone Beam Computed Tomography for the Assessment of the Proximity of Posterior Maxillary Apexes with the Maxillary Sinus: A Cross-sectional Study]]>https://eurekaselect.com/article/1327512024-03-28Background: The lack of knowledge of the relation of the maxillary sinus with the apexes of maxillary posterior teeth can lead to important complications during common dental procedures. This can be avoided using different imaging techniques, such as orthopantomography (OPG) and cone beam computed tomography (CBCT). The present study aims to compare the performance of OPG with CBCT in measuring the vertical distance of the apexes of posterior-superior teeth to the maxillary sinus.

Methods: This study corresponded to a cross-sectional study. OPGs and CBCT scans were obtained from the same individuals, and the qualitative and quantitative vertical distance of the apexes in relation to the maxillary sinus was categorized and measured in mm.

Results: A total of 28 pairs of OPGs and CBCT scans from the same patients were obtained. About 381 roots were analysed, which included 89 upper first premolars, 51 upper second premolars, 115 upper first molars, and 126 upper second molars. Projection/protrusion was observed with more frequency in molars, specially 1º molars in both OPG (n= 75, 65.2%) and CBCT (n= 31, 27%); however, 106 more cases (27.9%) were classified as projected in the OPG compared to CBCT (p < 0.05). When comparing the performance of the OPG and CBTC for analysing all roots qualitatively, there was a 57.8% agreement between both techniques. This difference was statistically significant (p <0.0001). Statistically significant differences were also observed when comparing the millimetric differences.

Conclusion: This study showed that OPG is not an accurate technique to observe the relationship between the maxillary sinus and the apexes of the upper posterior teeth. In those cases where precision is required when performing dental procedures in this area, CBCT should be used. When not available, the clinicians should be aware of the limitations of the OPG and add other complementary techniques.

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<![CDATA[Can Uterine Artery Pulsatility Index Predict Fetal Chromosomal Abnormality in Early Pregnancy Loss? A Retrospective Cohort Study]]>https://eurekaselect.com/article/1329052024-03-28Background: Early pregnancy loss (EPL) or spontaneous loss of an intrauterine pregnancy within the first trimester occurs commonly worldwide. It is useful to predict the possibility of fetal chromosomal abnormalities using other cheap and easily available markers.

Objective: This study aimed to evaluate whether the uterine artery pulsatility index (UtA-PI) can predict fetal chromosomal abnormality in early pregnancy loss (EPL).

Methods: This was a retrospective cohort study including 148 women who underwent dilation and curettage for missed abortion. The UtA-PI was measured and evaluated by transvaginal ultrasound. Abnormal UtA-PI was identified through the mean of left and right UA-PI ≥ 90th percentiles of the relevant values for the corresponding gestational age. Copy number variation sequencing (CNV-seq) was performed on EPL cases without maternal cell contamination.

Results: 107 (72.3%) cases were classified with normal UtA-PI, while 41 (27.7%) cases were classified with abnormal UtA-PI. The fetal chromosomal abnormality rate was significantly higher in cases with normal UtA-PI than in those with abnormal UtA-PI (67.3% vs 22.0%, P = 7.1 × 10-7). Compared to cases with abnormal UtA-PI, the risk of fetal chromosomal abnormalities in cases with normal UtA-PI increased with an odds ratio of 7.3 (95% confidence interval [CI]: 3.2‒17.0, P = 4 × 10-7). The predictive value of normal UtA-PI alone for fetal chromosomal abnormalities was shown to have an area under the curve of 0.67‒0.71 in our population.

Conclusion: The UtA-PI seems to be lower and less likely to be elevated in EPL with fetal chromosomal abnormalities compared to those without aneuploidies. We suggest that UtA-PI should be examined in all EPL patients.

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<![CDATA[A Lightweight Super-resolution Network with Skip-connections]]>https://eurekaselect.com/article/1319952024-03-28Introduction: In some hospitals in remote areas, due to the lack of MRI scanners with high magnetic field intensity, only low-resolution MRI images can be obtained, hindering doctors from making correct diagnoses. In our study, high-resolution images can be obtained through low-resolution MRI images. Moreover, as our algorithm is a lightweight algorithm with a small number of parameters, it can be carried out in remote areas under the condition of the lack of computing resources. Moreover, our algorithm is of great clinical significance in providing references for doctors' diagnoses and treatment in remote areas.

Methods: We compared different super-resolution algorithms to obtain high-resolution MRI images, including SRGAN, SPSR, and LESRCNN. A global skip connection was applied to the original network of LESRCNN to use global semantic information to get better performance.

Results: Experiments reported that our network improved SSMI by 0.8% and also achieved an obvious increase in PSNR, PI, and LPIPS compared to LESRCNN in our dataset. Similar to LESRCNN, our network has a very short running time, the small number of parameters, low time complexity, and low space complexity while ensuring high performance compared to SRGAN and SPSR. Five MRI doctors were invited for a subjective evaluation of our algorithm. All agreed on significant improvements and that our algorithm could be used clinically in remote areas and has great value.

Conclusion: The experimental results demonstrated the performance of our algorithm in super-resolution MRI image reconstruction. It allows us to obtain highresolution images in the absence of high-field intensity MRI scanners, which has great clinical significance. The short running time, a small number of parameters, low time complexity, and low space complexity ensure that our network can be used in grassroots hospitals in remote areas that lack computing resources. We can reconstruct high-resolution MRI images in a short time, thus saving time for patients. Our algorithm is biased towards clinical and practical applications, and doctors have affirmed the clinical value of our algorithm.

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<![CDATA[Mammography and Ultrasonography Manifestations of Sclerosing Lymphocytic Lobulitis of the Breast: A Series of Seven Case Reports]]>https://eurekaselect.com/article/1342482024-03-28Objective: The present study aimed to analyze mammography and ultrasonography (US) manifestations of sclerosing lymphocytic lobulitis (SLL) of the breast.

Methods: A total of 8 pathologically confirmed SLL lesions from seven women (with one patient having bilateral breast lesions) were included in the study. All patients underwent preoperative mammography and US examinations. The findings from both modalities were classified and compared to their corresponding clinical data.

Results: Four patients were diagnosed with diabetes mellitus. Mammography results revealed that seven lesions presented as focal asymmetry or asymmetry. Seven lesions were observed as non-mass lesions on US examination. The most commonly observed US lesion features were as follows: seven lesions had focal non-ductal hypoechoic areas (87.5%), seven lesions exhibited posterior shadowing (87.5%), all lesions showed no vascularity or vessels in the rim (100%), no lesion had calcifications (0%), five lesions had an elasticity score of 3 (100%), one lesion showed retraction on the coronal plane (20%), and one lesion displayed a skipping sign on the coronal plane (20%). Based on these US findings, seven lesions (87.5%) were classified as BI-RADS 4.

Conclusion: The mammography findings for SLL are often nonspecific. However, the US features of SLL typically present as non-mass lesions. The absence of calcification and vascularity and no retraction on the coronal plane inside the lesion may help to differentiate this disease from the conventional forms of breast carcinoma.

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<![CDATA[The Evaluation of Subcutaneous and Visceral Adipose Tissue Changes by Computed Tomography in Coronavirus Disease 2019 and Comparison with Quantitative Analysis of Lung Involvement]]>https://eurekaselect.com/article/1335092024-03-28Background: This study aims to reveal the relationship between lung involvement and visceral adipose tissue changes between chest-computed tomography (CT) scans taken in short intervals in COVID-19 patients.

Methods: The retrospective study included 52 patients who tested positive for SARS-CoV-2. All patients had two chest CT exams. Lung involvement measurements were calculated by using an artificial intelligence tool. Visceral and subcutaneous fat tissue was measured at the level of the first lumbar vertebra on chest CT. Additionally, demographic and laboratory data were collected.

Results: 52 patients were included (36.5% female, mean age 50). Visceral fat area and visceral fat thickness changes were significantly positive predictors of total lung involvement changes (p=0.033, p=0.00024). Subcutaneous fat area and subcutaneous fat thickness changes were not associated with lung involvement change (p>0.05). CRP, IL-6, d-dimer, and ferritin levels were higher in patients who need intensive care units.

Conclusion: Visceral adipose tissue changes may indicate that it can have a role as a reservoir of virus involvement.

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<![CDATA[An Automatic Method Framework for Personalized Knee Prosthetic Modeling Based on Kinematic Geometry]]>https://eurekaselect.com/article/1336002024-03-28 <![CDATA[Multiple Parotid Sebaceous Lymphadenoma: A Case Report and Review of the Literature]]>https://eurekaselect.com/article/1340592024-03-28Introduction/Background: Sebaceous lymphadenoma is a rare parotid gland neoplasm. Up to now, there have been several studies that have discussed the imaging manifestations of salivary sebaceous lymphadenoma. In this paper, we have reported a case of multiple parotid sebaceous lymphadenoma demonstrated by ultrasound, CT scan, and MRI examinations, including diffusion-weighted imaging. To the best of our knowledge, this report is the first one on DWI findings of sebaceous lymphadenomas, and also the first report on multiple lesions in unilateral parotid gland.

Case Presentation: A 41-year-old woman presented with a nodule in the left parotid region. The lesion has grown slowly for 2 months and was not associated with any discomfort. Ultrasound, CT scan, and MRI examinations, including diffusion-weighted imaging, showed multiple nodules in the left parotid gland of a 41-year-old woman. These nodules were heterogeneous on CT scan and MRI examinations, and intratumorally multifocal fat and cystic areas were detected. On ultrasound examination images, these lesions were heterogeneous hypoechoic echotexture with multifocal irregular hyperechogenic areas, without significant blood flow. The patient underwent a left parotidectomy. Histopathologic sections showed nests of sebocytes distributed in lymphoid follicles and lymphocyte background, with obvious cystic changes. The patient recovered after receiving left parotidectomy. The microscopy diagnosis was parotid sebaceous lymphadenoma.

Conclusion: This case highlights the main imaging feature of parotid sebaceous lymphadenomas, namely an intraparotid heterogeneous nodule containing multifocal fat and cystic areas, and its possible origination from an intraparotid lymph node. This case also indicates that this rare lesion may involve multiple occurrences.

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<![CDATA[Discrimination between Benign and Malignant Lung Lesions using Volumetric Quantitative Dynamic Contrast-enhanced MRI]]>https://eurekaselect.com/article/1332232024-03-28Background: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is considered a promising method in lung lesion assessment.

Methods: Sixty-four patients with single pulmonary lesions (SPLs) received DCE-MRI at 3.0 T. Of them, 49 cases were diagnosed with lung cancer, and 15 with benign pulmonary nodules (8 inflammatory nodules, 5 tuberculosis, and 2 abscesses). SPLs were quantitatively analyzed to determine the pulmonary lesions-related perfusion parameters, including reflux constant (Kep), volume transfer constant (Ktrans), the maximum slope of increase (MaxSlope), extravascular extracellular space volume fraction (Ve), apparent diffusion coefficient (ADC), the initial area in the signal intensitytime curve (IAUGC), and contrast-enhancement ratio (CER). In addition, a Student’s t-test was conducted to calculate statistical significance regarding the quantitatively analyzed perfusion parameters in benign SPLs compared to malignant SPLs. The area under (AUC) the receiver operating characteristic (ROC) curve was studied to investigate the performance of perfusion parameters in diagnosing lung cancer.

Results: Values of Ktrans, Kep, Ve, MaxSlope, and IAUGC increased within malignant nodules relative to benign nodules (Ktrans: 0.21 ±0.08 vs. 0.73 ±0.40, P = 0.0001; Kep: 1.21 ±0.66 vs. 1.83 ±0.90, P = 0.0163; Ve: 0.24 ±0.08 vs. 0.47 ±0.18, P < 0.0001; MaxSlope: 0.09 ±0.14 vs. 0.28 ±0.29, P = 0.0166; IAUGC: 0.18 ±0.09 vs. 0.55 ±0.34, P = 0.0001). Meanwhile, malignant nodules presented higher ADC than benign nodules (0.0016 ±0.0006 vs. 0.0012 ±0.0003, P = 0.0019). Ktrans and IAUGC showed the best diagnostic performance with AUCs [1.0, 95%CI (0.99–1.0); 0.93, 95%CI(0.85–1.0), respectively].

Conclusion: Malignant pulmonary lesions had higher values of Ktrans, Ve, Kep, MaxSlope, and IAUGC compared to benign pulmonary lesions. Overall, perfusion parameters of DCE-MRI facilitate discrimination between benign from malignant pulmonary nodules.

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<![CDATA[An Extra-articular Ganglion Cyst with Multiple Fluid-fluid Levels]]>https://eurekaselect.com/article/1334612024-03-28Introduction: Ganglion cysts are the knee’s most common benign soft tissue tumors. Ganglion cysts are seen as multiloculated fluid collections on magnetic resonance imaging (MRI), and fluid-fluid levels are not an expected finding.

Case Presentation: A 36-year-old female patient presented with swelling in her right knee. Magnetic resonance imaging revealed a multiseptated cyst with multiple fluid-fluid levels within the anterior of the right patellar tendon. Open surgical excision was performed, and the pedicle of the cyst was dissected. The histopathology revealed a ganglion cyst with hemorrhage.

Conclusion: The ganglion cysts should be considered in the differential diagnosis of lesions with fluid-fluid levels, in addition to hemangioma, synovial sarcoma, and aneurysmal bone cysts of soft tissues.

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<![CDATA[Value of Multimodal Diffusion-weighted Imaging in Preoperative Evaluation of Ki-67 Expression in Endometrial Carcinoma]]>https://eurekaselect.com/article/1335642024-03-28Purpose: To investigate the value of multimodal diffusion weighted imaging (DWI) in preoperative evaluation of Ki-67 expression of endometrial carcinoma (EC).

Materials and Methods: Patients who had undergone pelvic DWI, intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) sequence MRI scan before surgery were retrospectively enrolled. Single index model, double index model, and DKI were used for post-processing of the DWI data, and the apparent diffusion coefficient (ADC), real diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), non-Gaussian mean diffusion kurtosis (MK), mean diffusion coefficient (MD) and anisotropy fraction (FA) were calculated and compared between the Ki-67 high (≥50%) and low (<50%) expression groups.

Results: Forty-two patients with a median age of 56 (range 37 - 75) years were enrolled, including 15 patients with a high Ki-67 (≥50%) expression and 27 with a low Ki-67 (<50%) expression. The MK (0.91 ± 0.12 vs. 0.76 ± 0.12) was significantly (P<0.05) higher while MD (0.99 ± 0.17 vs. 1.16 ± 0.22), D (0.55 ± 0.06 vs. 0.62 ± 0.08), and f (0.21 vs. 0.28) were significantly (P<0.05) lower in the high than in the low expression group. The combined model of MK, MD, D, and f-values had the largest area under the curve (AUC) value of 0.869 (95% CI: 0.764-0.974), sensitivity 0.733 and specificity 0.852, followed by the MK value with an AUC value 0.827 (95% CI: 0.700-0.954), sensitivity 0.733 and specificity 0.815.

Conclusions: IVIM and DKI have certain diagnostic values for preoperative evaluation of the EC Ki-67 expression, and the combined model has the highest diagnostic efficiency.

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<![CDATA[Electromagnetically Navigated Tube Placement Device for Bedside Placement of Small Bowel Feeding Tube on Patients with Acute Severe Pancreatitis: Comparative Study]]>https://eurekaselect.com/article/1335672024-03-28Background: A developing approach for the bedside installation of feeding tubes is the Electromagnetic Navigation-assisted Tube Placement Device (ENTPD). The ENTPD monitors the tip position of feeding tubes when they are inserted into the digestive tract. It aids in the avoidance of airway misalignment and allows placing into the small bowel. Several recent exploratory studies have shown that ENTPD for nasojejunal feeding tube installation can improve success rates, lower costs, and allow for a more rapid beginning of enteral nutrition.

Objectives: The aim of this study was to compare the effect of using an ENTPD for bedside placement of small bowel feeding tubes with blind placement on patients with acute severe pancreatitis and to see how well the electromagnetic navigation trajectory image (ENTI) and X-ray agreed on the location of the tube tip after placement.

Methods: The study was done prospectively using randomized and single-blind methods. The 65 cases used electromagnetic navigation-assisted placement, and 58 cases were blind placement. For judging the tube tip location, we compared the success rate, median time, number of repeat placements, complications, and agreement of ENTI vs. X-ray.

Results: The blind placement group's success rate was 86.21% compared to the ENTPD's 95.38%, P = 0.075. The median time was significantly longer in the blind placement group (116.55 ± 68.62 min vs. 25.37 ±12.63 min, P=0.000); the average number of repeating placements was 3.02 ± 1.21 vs. 1.16 ± 0.31 (Blind placement vs. ENTPD, P = 0.002). It provided a high degree of agreement between ENTI and X-ray after contrast, κ=0.752 [95% confidence interval, 0.67-0.84]. No complications occurred in the two groups.

Conclusion: ENTPD was used safely and effectively at the bedside to help patients with acute severe pancreatitis get feeding tubes. It not only improved the high successful rate of placement, decreased the time and reduced the exposure to X-ray, but it was also very convenient for bedside placement because of the portable equipment.

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<![CDATA[Liesegang Rings in Kidney Diseases- A Systematic Review]]>https://eurekaselect.com/article/1337222024-03-28Introduction: Liesegang rings (LR) are concentric acellular lamellar structures, usually found in cystic and inflammatory tissues but can also be seen in neoplastic conditions. They have been mistakenly interpreted as various structures like psammomatous calcification, parasites, and algae. This study has aimed to systematically review and summarize the existence of LRs in both non-neoplastic and neoplastic conditions of the kidney. The systematic search in PUBMED, PUBMED CENTRAL, and EMBASE along with Google Scholar was performed by using Kidney, Liesegang Rings, or Liesegang structure or pseudo parasitic structure in combination with the Boolean operators ‘’and” as searching terms. Data was collected for demographic characteristics and histopathology diagnosis. The search function was limited to human subjects. Two reviewers independently performed the eligibility assessment and data extraction. Eligibility inclusion criteria were all publications in the English literature worldwide related to Liesegang rings in association with kidney’s non-neoplastic and neoplastic conditions, regardless of the years of publication. Also included were those cases whose full articles were unavailable, but the abstract was well-described, fulfilling our inclusive criteria. Eligibility exclusion criteria included LRs found elsewhere in the body organs apart from the kidney and availability of full text in a different language, nonhuman, and duplicate article/case.

Methods: After the exclusion of the articles as per the exclusion criteria, the total articles that fulfilled the inclusive criteria were reviewed. In addition, all the articles were further cross-referenced for additional articles. All published papers retrieved from this search were considered for this review. A total of 22 records (26 cases) were found with a diagnosis of LRs in the kidney to date. Some articles were published as case series. Accordingly, 26 patients were reported to have Liesegang rings associated with kidney neoplastic and non-neoplastic conditions, 12 were male and 14 were female. For one case the gender was not mentioned. LRs presented a higher frequency in individuals between 4th and 5th decades of life. No single case was reported in infants and younger children. Regarding predisposing factors for LRs, cystic fluid contents were the most common underlying condition.

Results: In our practice, we encountered an unusual case of a 55-year-old female with a complaint of pain in the left upper quadrant of the abdomen. The ultrasound revealed nephrolithiasis and chronic kidney disease for which a nephrectomy was performed. On the histopathological examination, there was an incidental finding of Liesegang rings and a papillary adenoma along with features of chronic pyelonephritis. Our review will provide insight about LRs in different spectrums of kidney diseases.

Conclusion: This study represents the first available systematic review of the literature demonstrating LRs in the kidney. Although Liesegang rings have no great clinical significance, these, presence in both tissue and cytological specimens should be kept in mind while dealing with different lesions of the kidney as these are good mimickers of many organic and inorganic substances, parasites, and malignancies.

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<![CDATA[Assessment of Diagnostic Performance of Risk Factors Affecting Extraprostatic Extension: Role of Zonal Level of Prostate Cancer]]>https://eurekaselect.com/article/1343612024-03-28Objective: Extraprostatic extension (EPE) serves as a crucial marker of prostate cancer aggressiveness and independently predicts the likelihood of biochemical recurrence (BCR), exhibiting a strong correlation with the histologic severity of EPE. Therefore, this study aimed to investigate the probability of EPE along the zonal level of the prostate by measuring tumor contact length (TCL) using multiparametric magnetic resonance imaging (mpMRI).

Patients and Methods: Records of 308 patients who had undergone radical prostatectomy (RP) were identified. Tumor levels in the prostate were categorized as apex, mid-gland, and base, after which the correlation between TCL measured using MRI and microscopic EPE on pathologic specimens was evaluated. Univariable and multivariable logistic regression analyses were performed to assess the association among tumor origin, index tumor diameter, and TCL measured using MRI and microscopic EPE in RP specimens.

Results: Among the 214 patients included, 45 apical cancers (21%), 87 mid-gland cancers (41%), and 82 base cancers (38%) were observed. Pathological reports revealed that 18 (40.0%) apex, 31 (35.6%) mid-gland, and 50 (61.0%) base tumors were pT3a. Multivariable analysis demonstrated that the zonal level of the tumor, especially the base level, was an independent predictive factor for EPE (P < 0.001), and the AUC value of the base tumor was 0.858.

Conclusion: Prostate cancers arising from the base were more likely to exhibit EPE than those arising from the mid-gland and apex of the prostate gland. Therefore, identifying the origin of the zonal level of prostate cancer may help guide treatment decisions and predict clinical prognosis.

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<![CDATA[COVID-19 Detection using Hybrid CNN-RNN Architecture with Transfer Learning from X-Rays]]>https://eurekaselect.com/article/1337202024-03-28Introduction: Millions of people have been infected with COVID-19, which has spread quickly worldwide since the start of 2020, resulting in numerous fatalities. Identification of infected individuals is essential to control the spread of the virus.

Aims: In this study, we propose a hybrid architecture that combines Convolutional Neural Networks (CNNs) with Recurrent Neural Networks (RNNs) and leverages transfer learning to enhance the accuracy of COVID-19 detection from X-ray images.

Methods: The proposed work utilizes 4 pre-trained CNN architectures, namely, InceptionnetV3, Densenet121, Inception-ResNet V2, and VGG19, to extract high-level features from the input X-ray images. These features are then fed into the second component, an RNN-based network, which captures the temporal dependencies within the extracted features. To evaluate the performance of the proposed architecture, a comprehensive dataset consisting of X-ray images from COVID-19 positive cases, non-COVID-19 pneumonia cases, and healthy individuals is used. Gradient class activation map (Grad-CAM) analysis has been applied to the obtained results to provide heat-map pictures specific to each class and coloured visualizations of the COVID-19-infected areas in CXR images.

Results: : Experimental results demonstrate that the proposed hybrid CNN-RNN architecture achieves promising results in COVID-19 detection from X-ray images. The model exhibits high accuracy, precision, recall, area under the receiver operating characteristics (ROC) curve (AUC), and F1-score, outperforming other state-of-the-art methods.

Conclusion: The combination of CNNs and RNNs enables the model to effectively capture spatial and temporal information, leading to improved performance in COVID-19 detection. The proposed hybrid architecture with transfer learning from X-ray images provides a robust and efficient solution for COVID-19 detection. The model can potentially assist healthcare professionals in making accurate and timely diagnoses, thereby contributing to the global efforts to combat the COVID-19 pandemic. In the present work, VGG19-RNN architecture outperformed all other networks in terms of accuracy. The most effective training and validation accuracy for the VGG19-RNN architecture is 99% & 97.70%, respectively, and the loss was 0.02 & 0.09 at epoch 100.

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<![CDATA[Comprehensive Introspection of Magnetoresistive Sensors Applied in Biomedical Diagnostics]]>https://eurekaselect.com/article/1340612024-03-28 <![CDATA[Dual-energy Spectral CT Imaging of Primary Anorectal Malignant Melanoma: A Case Report]]>https://eurekaselect.com/article/1341272024-03-28Background: Primary anorectal malignant melanoma (ARMM) is a rare tumor. It is often misdiagnosed as hemorrhoids, polyps or colorectal cancer due to the lack of specificity of their clinical symptoms and imaging manifestations.

Case Presentation: In this study, we reported an 83-year-old female patient with ARMM. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) showed uneven thickening of the intestinal wall about 7.0 cm from the anal margin, and no typical T1 high signal was seen on MRI. Dual-energy spectral CT showed that the effective atomic number (Zeff) of the tumor and the iodine concentration in the arterial phase (AP) and venous phase (VP) were different from other rectal malignancies reported in the previous literature. Sigmoidoscopy showed a large polypoid mass approximately 7.0 cm from the anal verge. Immunohistochemical staining showed that about 60% of Melan A and HMB-45 were positive, S-100 protein and Ki-67 were positive, and the pathological diagnosis was ARMM.

Conclusion: This was the first dual-energy spectral CT imaging report of ARMM. The Zeff and iodine concentration in the arterial phase and venous phase could help distinguish between ARMM and other rectal malignancies.

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<![CDATA[Esophageal Hematoma Mimicking Esophageal Varices after Chewing Betel Nut: A Case Report]]>https://eurekaselect.com/article/1341832024-03-28Background: Betel nut chewing is very common in Southeast Asia and other tropical countries. Much clinical evidence suggests that chewing betel nut has proinflammatory and carcinogenic effects, but there are few clinical reports of acute toxicity caused by it, especially involving esophageal damage.

Case presentation: We presented a case of a 72-year-old female who was admitted to our hospital for chest pain and hematemesis within several minutes after chewing betel nut. Gastroscopy showed two longitudinal ridge-like mucosal eminences in the esophagus located 20 cm from the incisors down to the gastric cardia, which was similar to varices. At last, a CT scan showed concentric-circle thickening of the esophagus wall, suggesting hematomas. Our treatment included fasting, inhibiting gastric acid and maintaining blood volume. After one week of medical treatment, rechecked gastroscopy showed that esophageal hematomas were gradually absorbed, with the formation of multiple shallow ulcers.

Conclusion: The acute toxicity of chewing betel nut can be easily overlooked. Patients who experience chest pain or hematemesis after chewing betel nut products,especially those who take aspirin at the same time, need to be alert to esophageal hematoma.

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<![CDATA[Assessment of Apparent Diffusion Coefficient Parameters and Coefficient of Variance in Discrimination of Receptor Status and Molecular Subtypes of Breast Cancer]]>https://eurekaselect.com/article/1343042024-03-28Objective: The objective of this study was to investigate the diagnostic power of apparent diffusion coefficient/coefficient of variance (ADCcV) as well as ADC parameters formed based on magnetic resonance images (MRI) in the distinction of molecular breast cancer subtypes.

Methods: The study involved 205 patients who had breast cancer at stages 1-3. Estrogen receptor (EsR), progesterone receptor (PrR), human epidermal growth factor receptor 2 (Her2), and proliferation index (Ki-67) were histologically analyzed in the tumor. The correlations between the immunohistochemistry and intrinsic subtypes were analyzed using ADC and ADCcV.

Results: The maximum whole tumor (WTu) ADC (p=0.004), minimum WTu ADC (p<0.001), and mean WTu ADC (p<0.001) values were significantly smaller in the EsR-positive tumors than those in the EsR-negative tumors. Compared to the PrR-negative tumors, the PrR-positive tumors showed significantly smaller maximum, minimum, and mean WTu ADC values (p=0.005, p=0.001, and p<0.001, respectively). In the comparisons of the molecular subtypes in terms of ADCcV, the p-values indicated statistically significant differences between the luminal A (lumA) group and the triple negative (TN) group, between the luminal B (lumB) group and the TN group, and between the Her2-enriched and TN groups (p<0.001, p=0.011, and p=0.004, respectively). Considering the luminal and non-luminal groups, while a significant difference was observed between the groups considering their minimum, maximum, and mean WTu ADC values, their ADCcV values were similar (p<0.001, p=0.004, and p<0.001, respectively).

Conclusion: Using ADCcV in addition to ADC parameters increased the diagnostic power of diffusion weighted-MRI (DW-MRI) in the distinction of molecular subtypes of breast cancer.

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<![CDATA[Comparative Study of CT and MR Guided Microwave Ablation in the Treatment of Para-vascular VX2 Liver Tumor Model in Rabbits]]>https://eurekaselect.com/article/1343582024-03-28Objective: To analyze the efficacy of microwave ablation (MWA) guided by computed tomography (CT) and 1.5T magnetic resonance (MR) in the treatment of VX2 para-vascular liver tumor model in rabbits.

Materials and Methods: Sixty para-vascular VX2 liver tumor models in rabbits were randomly divided into CT-guided microwave ablation group (CT group, n=35) and MR-guided microwave ablation group (MR group, n=35). The complete ablation rate, mean operation time, postoperative complication rate and mean survival time were compared between the two groups.

Results: In the CT group, the rate of complete ablation was 68.6% (24/35), and the mean operation time was 42.1 ± 9.7 minutes. Three cases had ascites and one case had abdominal wall injury. In the MR group, the rate of complete ablation was 94.2% (33/35), and the mean operation time was 53.4 ± 10.9 minutes. One case was complicated with ascites. No serious complications such as pneumothorax, liver abscess, pleural effusion and diaphragm perforation were found in both groups. Between the two groups, the difference in complete ablation rate was statistically significant (P=0.006 < 0.05). A statistically significant difference can also be found in mean operation time (P < 0.01). The follow-up time was 21 days after the operation. As for the postoperative complication rate (11.4% in the CT group and 2.9% in the MR group, P=0.353) and mean survival time (16.9 ± 1.8 days in CT group, 18.3 ± 2.3 days in the MR group, P=0.925), the differences were not statistically significant.

Conclusion: Compared with CT guidance, although the microwave ablation time under MR guidance was longer, the complete ablation rate under MR guidance was high, which proved that MR guidance was a more effective way of microwave ablation guidance and was worth promoting in the clinic. In this experiment, the postoperative complication rate was lower in the MR group, although the difference was not statistically significant, which may be related to the small sample size, and the subsequent study on the postoperative complication rate can increase the sample content.

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<![CDATA[TIPS with a Twist – The Real Life Management of a Case of Budd-Chiarirelated Acute Liver and Subsequent Multiple Organ Failure]]>https://eurekaselect.com/article/1343642024-03-28Introduction: Budd-Chari syndrome (BCS) is a rare condition defined by the obstruction of hepatic venous outflow. BCS is a relatively infrequent cause of acute liver failure (ALF), accounting for less than 1% of cases. Treatment for acute BCS consists of a stepwise approach, requiring anticoagulation, angioplasty, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation.

Case Report: We present the case of a 31-year-old female patient with BCS, which led to ALF and subsequent multiple organ failure, which was successfully treated with TIPS and endovascular coil placement. Initial diagnostic workup revealed the complete obstruction of the hepatic venous outflow, spleno-mesenteric confluent thrombosis, and biochemical criteria of ALF. Her condition rapidly deteriorated towards multiple organ failure. At one point, the MELD score was 42, while the SOFA score predicted a mortality rate of >95%. Following continuous venovenous hemodiafiltration with cytokine adsorbent filters, TIPS was inserted, resulting in a portal pressure gradient (PPG) of 14 mmHg. Following TIPS, the patient had persistent ascites and later presented an episode of gastric variceal bleeding with endoscopic and surgical treatment failure. TIPS revision with further dilation led to a final PPG of 6 mmHg. During the procedure, selective embolization by coil placement of the spleno-gastric collateral circulation ultimately resolved the variceal bleeding. In the aftermath, the patient had complete organ failure remission and was successfully discharged with no ascites, encephalopathy, or significant impairment regarding daily life activities.

Conclusion: In the rare setting of BCS complicated with ALF and portal hypertension-related complications, TIPS and endovascular embolization provide a unique, effective, and against-all-odd solution.

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<![CDATA[Venous Air Embolism: Case Series of a Complication of Computed Tomography Pulmonary Angiography (CTPA) in the Emergency Department of Medicine]]>https://eurekaselect.com/article/1340602024-03-28Introduction: Venous air embolism (VAE) consists of air entering vascular structures due to a pressure gradient generated during medical-surgical procedures. Most cases of VAE are iatrogenic.

Case Reports: Three hospitalised patients aged 23 to 86 years underwent venous air embolism (VAE) in the right heart system after performing CTPA. One of the patients died from a complication of venous thromboembolic disease (PE, coronary sinus thrombosis, mesenteric venous thrombosis).

Conclusion: CTPA is a procedure that a priori seems innocuous, but it can be a potential cause of death or serious consequences for patients undergoing radiological procedures where the administration of contrast and the use of an injector could be counterproductive. Radiologists and physicians responsible for the patient should be aware of vascular gas embolism after contrast injection in patients undergoing CTPA.

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<![CDATA[The Efficiency of the CT Radiomics Model in Assessing the Microsatellite Instability of Colorectal Cancer Liver Metastasis]]>https://eurekaselect.com/article/1340632024-03-28Objective: This study aims to investigate the efficiency of a radiomics model in identifying high-frequency microsatellite instability (MSI-H) and microsatellite stability (MSS) of colorectal liver metastasis (CRLM) according to machine learning radiomics features of enhanced CT liver images.

Materials and Methods: A total of 12 patients with MSI-H CRLM and 96 patients with MSS CRLM were randomly divided into the training group and internal validation group according to the ratio of 7: 3 (training: 75 cases, validation: 33 cases). From the enhanced CT (portal phase) image data of patients, 788 radiomics features were extracted, and a random forest model was established with the optimal features selected. The receiver operating characteristics (ROC) curve analysis was performed to assess the model’s diagnostic efficacy.

Results: The training group comprised 8 patients with MSI-H CRLM and 67 patients with MSS CRLM, and the internal validation group included 4 patients with MSI-H CRLM and 29 patients with MSS CRLM. After feature selection, 7 radiomics features good for distinguishing MSI-H CRLM and MSS CRLM were screened out. The ROC curve analysis demonstrated that the random forest model had the AUC (area under the ROC curve) value 0.88, accuracy 0.85, sensitivity 0.85, specificity 0.92, and F1 score 0.88 in the training group. The model had an AUC value of 0.75, accuracy of 0.74, sensitivity of 0.81, specificity of 0.85, and F1_score of 0.78 in the internal validation group in identifying the MSI-H from the MSS CRLM. In order to evaluate the robustness of the overall model, the 788 features obtained were all applied to the 5-fold cross-validation, with the model being built on the random forest and analyzed with the ROC curve analysis. The AUC value of the model was 0.86 (P<0.05), accuracy value 0.91, sensitivity 0.60, and specificity 0.95.

Conclusion: The random forest prediction model built on the radiometric features extracted from enhanced CT images can be used to identify the MSI-H from the MSS CRLM and may provide effective guidance for clinical immunotherapy of CRLM patients with unknown MSI status.

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<![CDATA[Identifying Tumor Deposits in Patients with Locally Advanced Rectal Cancer: using Multiplanar High-Resolution T2WI]]>https://eurekaselect.com/article/1340642024-03-28Background: The prognosis of postoperative tumor deposits (TDs) is worse than positive lymph node metastases alone.

Objective: To detect TDs by using multiplanar high-resolution T2-weighted imaging (HRT2WI).

Material and Methods: This retrospective study enrolled 130 patients with locally advanced rectal cancer (LARC). Using pathology-proven tumor deposits (pTDs) as the gold standard, all patients were divided into the pTDs-negative and pTDs-positive groups, the correlation of clinicopathological factors and image features [such as MRI-detected tumor deposits (mTDs), MRI-detected metastatic lymph node (mLN), MRI-detected extramural vascular invasion (mEMVI), maximal extramural depth (EMD), etc.] with pTDs were analyzed by univariate analysis and multivariate binary logistic regression analysis, and the nomogram was established based on the latter. The diagnostic efficiency was evaluated by the receiver operating characteristic curve (ROC) analysis and area under curve (AUC).

Results: mTDs, mLN, mEMVI, and EMD were significantly different between the pTDs-positive and pTDs-negative groups (P < 0.05), with the AUC of 0.767, 0.746, 0.664 and 0.644, respectively. mTDs and mLN were independent risk factors for pTDs (odds ratio: 5.74 and 3.90, P < 0.05). The AUC, sensitivity, specificity, negative predictive value, and accuracy of the nomogram were 0.814 (95% CI: 0.720 ~ 0.908), 73.9%, 79.4%, 93.4%, and 78.5%, respectively. Seventeen of 23 patients with pTDs were identified as mTDs, with a moderate agreement between pTDs and mTDs (Kappa=0.419).

Conclusion: Multiplanar HRT2WI can be used as a preoperative diagnostic tool to identify TDs in LARC. The combined model constructed by mTDs and mLN shows a good diagnostic performance for TDs.

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<![CDATA[Segmentation of Ocular Thermogram Using Level-set Algorithm for Analysis of Contralateral Portions in Healthy Eyes]]>https://eurekaselect.com/article/1341242024-03-28Objective: This work aimed to evaluate the level set segmentation algorithm on ocular surface thermograms. In addition, the vascularity functioning between the contralateral portions of two eyes (right and left) was identified using statistical analysis methods.

Methods: A total of 25 healthy participants with an average age of 35 years (20 men and 5 women) were selected in April 2022. Thermogram images were captured using a FLIR T series thermal camera. Conventional image processing techniques, such as filtering and edge detection, were used to preprocess thermograms. Next, the level set approach was used with the edge-detected pattern as an input to an automated segmented region of interest (ROI).

Results: Five metrics, namely Dice Coefficient, Tanimoto Index, Jaccard Index, Volume Similarity, and Structural Similarity, were used to assess the performance of the segmentation technique compared to ground truth, which showed 97.5%, 92.5%, 94.5%, 96.5%, and 96.5% correlation, respectively, between the segmented and the ground truth images with average values for both the eyes. Statistical analysis demonstrated that the contralateral portions of the ocular thermograms were significantly different in terms of vascular distribution between the left and right eyes (p < 0.005).

Conclusion: The level set method efficiently segmented the ROI in ocular thermograms with maximum correlation. According to the segmentation’s results, the model showed the dissimilarity between the contralateral parts of the left and right eyes in healthy cases.

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<![CDATA[Predicting the Prognosis of Lung Cancer Patients Treated with Intensitymodulated Radiotherapy based on Radiomic Features]]>https://eurekaselect.com/article/1343012024-03-28Aims: This study aimed to develop a method for predicting short-term outcomes of lung cancer patients treated with intensity-modulated radiotherapy (IMRT) using radiomic features detected through computed tomography images.

Methods: A prediction model was developed based on a dataset of radiomic features obtained from 132 patients with lung cancer receiving IMRT. Dimension reduction was performed for the features using the maximum-relevance and minimum-redundancy (mRMR) algorithm, and the least absolute shrinkage and selection operator (LASSO) regression model was utilized to optimize feature selection for the IMRT-sensitivity prediction model. The model was constructed using binary logistic regression analysis and was evaluated using the concordance index (C-index), calibration plots, receiver operating characteristic curve, and decision curve analysis.

Results: Fifty features were selected from 1348 radiomic features using the mRMR method. Of these, three radiomic features were selected by LASSO logistic regression to construct the radiomics nomogram. The C-index of the model was 0.776 (95% confidence interval: 0.689–0.862) and 0.791 (95% confidence interval: 0.607–0.974) in the training and validation cohorts, respectively. Decision curve analysis showed that the radiomics nomogram was clinically useful.

Conclusion: Radiomic features have the potential to be applied to predict the short-term efficacy of IMRT in patients with inoperable lung cancer.

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<![CDATA[Coexistence of Large Meningioma and Arteriovenous Malformation: A Case Report and Literature Review]]>https://eurekaselect.com/article/1300962024-03-28Introduction The simultaneous presence of a giant intracranial meningioma and an arteriovenous malformation(AVM)in the same cerebral hemisphere is extremely rare. The treatment should be individualized depending on the case.

Case Presentation A 49-year-old man presented with hemiparesis. Preoperative neuroimaging revealed a giant lesion and an AVM on the left hemisphere of the brain. Craniotomy and tumour resection were performed. The AVM was not treated and needed to be followed up. The histological diagnosis was meningioma (World Health Organization grade I). The patient was in good neurological condition postoperatively.

Conclusion This case adds to the growing literature suggesting that the association between the two lesions is complex. Besides, treatment depends on the risk of neurologic function damage and hemorrhagic stroke of meningiomas and AVMs.

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<![CDATA[Is there a Relationship between Vertical Facial Development and Nasal Cavity?]]>https://eurekaselect.com/article/1328352024-03-28Objectives: The aim of this study was to examine the relationship between vertical direction differences and the nasal cavity in skeletal Class I individuals.

Materials and Methods: This study was divided into 2 groups according to the vertical direction angle, and it was conducted on a total of 60 individuals with skeletal Class I features, with 30 individuals in each subgroup. Angular and millimetric measurements (N-ANS, ANS-ME, N-ME, Ba-N/Ptm-Gn°, nasal septum, nasal cavity width (NCL), nasal cavity angle° (NCA)) were made in accordance with the parameters determined on cone beam computed tomography (CBCT) before the treatment of the individuals constituting the research groups. In a retrospective study, the relationship between vertical skeletal development of the nasal cavity on CBCT images was examined in detail. The Mann-Whitney U test was used, and Student's t test was used to compare two groups with a normal distribution. Spearman's correlation analysis was used to determine the relationship between quantitative data.

Results: In the comparison of Class I vertical direction subgroups, a statistically significant difference was found in terms of measurement values ANS-Me and N-Me, nasal cavity width and angular measurements (p<0.001) According to the results of the Mann-Whitney U test, men had significantly higher measurements of the sex and nasal cavity than women (p = 0.001; p<0.001).

Conclusion: Class I individuals with different vertical direction dimensions were affected by changes in the nasal cavity during vertical development.

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<![CDATA[An Early Detection and Classification of Alzheimer's Disease Framework Based on ResNet-50]]>https://eurekaselect.com/article/1340562024-03-28Objective: The objective of this study is to develop a more effective early detection system for Alzheimer's disease (AD) using a Deep Residual Network (ResNet) model by addressing the issue of convolutional layers in conventional Convolutional Neural Networks (CNN) and applying image preprocessing techniques.

Methods: The proposed method involves using Contrast Limited Adaptive Histogram Equalizer (CLAHE) and Boosted Anisotropic Diffusion Filters (BADF) for equalization and noise removal and K-means clustering for segmentation. A ResNet-50 model with shortcut links between three residual layers is proposed to extract features more efficiently. ResNet-50 is preferred over other ResNet types due to its intermediate depth, striking a balance between computational efficiency and improved performance, making it a widely adopted and effective architecture for various computer vision tasks. While other ResNet variations may offer higher depths, they are more prone to overfitting and computational complexity, which can hinder their practical application. The proposed method is evaluated on a dataset of MRI scans of AD patients.

Results: The proposed method achieved high accuracy and minimum losses of 95% and 0.12, respectively. While some models showed better accuracy, they were prone to overfitting. In contrast, the suggested framework, based on the ResNet-50 model, demonstrated superior performance in terms of various performance metrics, providing a robust and reliable approach to Alzheimer's disease categorization.

Conclusion: The proposed ResNet-50 model with shortcut links between three residual layers, combined with image preprocessing techniques, provides an effective early detection system for AD. The study demonstrates the potential of deep learning and image processing techniques in developing accurate and efficient diagnostic tools for AD. The proposed method improves the existing approaches to AD classification and provides a promising framework for future research in this area.

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<![CDATA[An 88-year-old Man with Rare Giant Liposarcoma of the Scrotum]]>https://eurekaselect.com/article/1341822024-03-28Background: Liposarcoma (LPS) is a malignant mesenchymal tumor that mostly occurs in the extremities and retroperitoneum and rarely in the scrotum.

Case Presentation: In this case report, we introduced a patient who was diagnosed with LPS in the scrotum. In his right scrotum, we found a large soft tissue mass, including fat and calcification.

Conclusion: We reviewed the clinical, pathological and computed tomography (CT) features of patients diagnosed with LPS of the scrotum to help improve the understanding of the disease and the accuracy of diagnosis.

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<![CDATA[Intratesticular Vascular Architecture Seen by Ultrasound Microvascular Imaging (MicroV). Illustration of the Testis Vascular Anatomy]]>https://eurekaselect.com/article/1343032024-03-28The testis is a richly vascularized organ supplied by low-flow thin caliber vessels that are only partially detected by traditional Doppler systems, such as color and power Doppler.

However, in the vascular representation, these techniques determine, albeit to different extents, a cut of the weak vessels due to the necessary application of wall filters that cut the disturbing frequencies responsible for artifacts generated by pulsations of the vascular walls and surrounding tissues.

These filters cut a specific range of disturbing frequencies, regardless of whether they may be generated by low-flow vessels.

Recently, a new technology, called Ultrasound Microvascular Imaging (MicroV) has been developed, which is particularly sensitive to slow flows. This new mode is based on new algorithms capable of better selecting the low frequencies according to the source of origin and cutting only the disturbing ones, saving the frequencies originating from really weak flows.

When Ultrasound microvascular imaging is used, the vascular map is more detailed and composed of macro and microvasculature, with more subdivision branches, facilitating the interpretation of the normal and, consequently, the pathological.

This review aims to describe the vascular architecture of the testis with Ultrasound Microvascular Imaging (MicroV) in healthy testis, compared to traditional color/power Doppler, related to normal anatomy.

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<![CDATA[GastroNet: A Custom Deep Learning Approach for Classification of Anomalies in Gastrointestinal Endoscopy Images]]>https://eurekaselect.com/article/1343062024-03-28Introduction: Among all cancer forms, gastrointestinal (GI) cancer is the most serious condition that spreads quickly and requires early detection. GI disorders claim the lives of up to nearly two million people worldwide. To lower the mortality rate from GI cancer, early detection is essential.

Methods: For the identification of GI illnesses, such as polyps, stomach ulcers, and bleeding, endoscopy is the gold standard in the medical imaging industry. The numerous images produced by endoscopy require an enormous amount of time for the specialist to diagnose the disease. It makes manual diagnosis difficult and has sparked research on automatic computer-based approaches to diagnose all the generated images quickly and accurately. AI-based algorithms have already been used in endoscopy images with promising outcomes and have enhanced disease identification and classification with precision. However, there are still a lot of issues to be solved, including figuring out potential biases in algorithms and improving interpretability and generalizability.

Results: The proposed GastroNet model creates a system for classifying digestive problems for the Kvasir Version 1 dataset. The framework consists of different CNN layers with multiple filters, and average max-pooling is used to extract image features. The optimization of network parameters is done using the Stochastic Gradient Descent (SGD) algorithm.

Conclusion: Finally, the robustness of the proposed model is compared with other state-of-the-art models like VGG 19, ResNet 50, Inception, and Xception in terms of evaluation metrics.

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<![CDATA[Deep Learning Mammography Classification with a Small Set of Data]]>https://eurekaselect.com/article/1335662024-03-28Background: Breast cancer is one of the leading causes of mortality among women. In addition, 1 in 8 women and 1 in 833 men will be diagnosed with breast cancer in 2022. The detection of breast cancer can not only lower treatment costs but also increase survival rates. Due to increased cancer awareness, more women are undergoing breast cancer screening, leading to more cases being diagnosed worldwide, but doctors' ability to analyze these images is limited. As a result, they get overloaded leading to misinterpretations. The advent of computer-aided diagnosis (CAD) minimized man’s involvement and achieved good results. CAD helps medical doctors automatically detect and analyze abnormalities found in the breast. Such abnormalities may be benign or malignant tumors.

Objective: The goal of this study is to evaluate the effectiveness of using seven layers to classify breast cancer as either benign or malignant using mammograms.

Materials and Methods: The open-source MIAS dataset of 322 images was used for our study, of which 207 were normal images and 115 were abnormal images. The proposed CNN model convolves an image into seven layers that extract features from the input images, and these features are used to classify breast cancer as malignant or benign.

Results: The proposed CNN used a limited data set and achieved the best result compared to previous work. The method achieved results with a 0.39% loss, 99.89% accuracy, 99.85% precision, 99.89% recall, 99.87% F1-score, and an area under the curve noted to be 100.0%.

Conclusion: CNN uses a small amount of data to determine abnormalities; the method will assist a medical doctor in determining whether or not a specific patient has cancer.

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<![CDATA[Ultrasound Diagnostic: Rapid Detection of Second Metatarsal Stress Fracture, Case Report and Literature Study]]>https://eurekaselect.com/article/1341842024-03-28Introduction: Ultrasound is extensively used for soft tissue pathology. Scanning bone superficial structures may reveal clear pathologic features to aid diagnosis.

Case presentation: We present the case of a stress fracture in the second metatarsal, with the clinical aspect of a gouty attack. Ultrasound examination showed cortical thickening and disruption, hypoechoic periosteal swelling, hyperemia, soft tissue edema, and displacement of the extensor tendon. The diagnosis was confirmed by X-ray and MRI. The value of different diagnostic tools is discussed, and the importance of gray-scale and color Doppler ultrasound as a first-hand modality is underlined.

Conclusion: Sonography clearly identifies cortical and periosteal abnormalities, differentiates surrounding soft tissue pathologies, and offers dynamic evaluation, and follow-up possibility with low cost, high accessibility, and no risks. Periosteal and cortical irregularities are important diagnostic issues when performing ultrasound examinations for soft tissue pathology.

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<![CDATA[Comparison of Computed Tomography Findings between Adult and Pediatric COVID-19 Patients]]>https://eurekaselect.com/article/1353572024-03-28Purpose: This study aims to compare chest computed tomography (CT) findings between adult and pediatric patients with coronavirus disease-19 (COVID-19) pneumonia.

Materials and Methods: This study included 30 pediatric patients aged 1 to 17 years and 30 adult patients over 18 years of age with COVID-19 pneumonia confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) who have findings related to COVID-19 on Chest Computed Tomography. The CT findings of adult and pediatric patients were compared with a z-test.

Results: Bilateral involvement (p:0.00056), involvement in all five lobes (p<0.00001), and central and peripheral involvement (p:0.01928) were significantly higher in the adult group compared to the pediatric group. In the pediatric group, the frequency of unilateral involvement (p:0.00056), involvement of solitary lobe (p:0.00132), and peripheral involvement (p: 0.01928) were significantly higher than in the adult group. The most common parenchymal finding in adults and pediatric patients was ground-glass opacities (100% and 83%, respectively). Among the parenchymal findings in adults, ground-glass opacities with consolidation (63%) were the second most common finding, followed by air bronchogram (60%) in adults, while in pediatric patients, halo sign (27%) and nodule (27%) were the second most common, followed by the ground-glass opacities with consolidation (23%).

Conclusion: The CT findings of pediatric COVID-19 patients must be well-known as the course of the disease is usually less severe, and the radiological findings are uncertain when compared with adults.

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<![CDATA[Establishment and Comparison of Piecewise Linear Regression Models to Measure Thyroid Volume by 2D and 3D Ultrasound]]>https://eurekaselect.com/article/1343662024-03-28Objective: Compared thyroid volumes measured by 2-D and 3-D US with those of resected specimens and proposed new models to improve measurement accuracy.

Methods: This study included 80 patients who underwent total thyroidectomy. One 2D_model and one 3D_model were developed using piecewise linear regression analysis. The accuracy of these models was compared using an ellipsoid model (2-D_US value × 0.5), 3-D_US value, and Ying’s model [1.76 + (2-D_US value × 0.38)].

Results: The new 2D_model was: V=2.66 + (0.71 * X1) - (1.51 * X2). In this model, if 2-D_US value <= 228.39, X1 = 2-D_US value and X2 = 0; otherwise, X1 = 2-D_US value and X2 = 2-D_US value - 228.39. The 3D_model was: V= 2.90 + (1.08 * X1) + (2.43 * X2). In this model, if 3- D_US value <= 102.06, X1 = 3-D_US value and X2 = 0; otherwise, X1 = 3-D_US value and X2 = 3-D_US value - 102.06. The accuracy of the new models was higher than that of the 3-D_US value, the ellipsoid model, and Ying’s model (P<0.05).

Conclusion: The models established are more accurate than the traditional ones and can accurately measure thyroid volume.

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<![CDATA[Correlation between Spectral CT Parameters and Ki67 Expression in Hepatocellular Carcinoma]]>https://eurekaselect.com/article/1352372024-03-28Objective: The objective of this study was to analyze the relationship between quantitative parameters of spectral CT and the Ki67 expression index of tumor cells in hepatocellular carcinoma (HCC).

Methods: A total of 19 patients who underwent preoperative spectral CT dual-phase enhancement and who were diagnosed with HCC by postoperative pathology were prospectively selected. Patients with ≥10% Ki67-positive tumor cells formed a high-Ki67 group, and those with <10% Ki67- positive cells formed a low-Ki67 group. The iodine concentrations (ICs) of the lesion and the descending aorta were measured during the arterial and venous phases. Relative iodine concentration (RIC) was calculated thus: RIC=IClesion/ICdescending aorta. CT values of the lesions at 40 and 70 keV were measured during the enhanced arterial and venous phases. The slope of the spectral curve (λ) was calculated thus: λ = (40 keV-70 keV) /(70-30). To compare the differences in quantitative parameters between the high- and low-Ki67 groups, either an independent samples t-test (normal distribution) or a Mann–Whitney U test (non-normal distribution) was used. Receiver operating characteristic curves were used to evaluate the effectiveness of spectral CT parameters in distinguishing between high-Ki67 and low-Ki67 groups. Pearson correlation analysis was used to evaluate the correlation between spectral CT quantitative parameters and Ki67 expression.

Results: IC, RIC and λ values for the high-Ki67 group in arterial and venous phases were higher than those for the low-Ki67 group, P < 0.05. IC, RIC, and λ values in the arterial phase were 0.83, 0.89, and 0.75, respectively; in the venous phase, the values of these three parameters were 0.76, 0.77, and 0.69, respectively. IC, RIC, and λ were positively correlated with Ki67 expression in both arterial and venous phases, with a highest correlation of 0.82 for arterial-phase RIC.

Conclusion: The quantitative parameters of spectral CT in HCC were correlated with Ki67 expression. This finding may make it easier for clinicians to determine whether a tumor is high or low in Ki67 before surgery.

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<![CDATA[A Segmentation Method of Serialized Human Body Slices based on Matting Strategy and Skeleton Extraction]]>https://eurekaselect.com/article/1317742024-03-28Introduction: In this paper, a semiautomatic image segmentation method for the serialized body slices of the Visible Human Project (VHP) is proposed.

Methods: In our method, we first verified the effectiveness of the shared matting method for the VHP slices and utilized it to segment a single image. Then, to meet the need for the automatic segmentation of serialized slice images, a method based on the parallel refinement method and flood-fill method was designed. The ROI (region of interest) image of the next slice can be extracted by using the skeleton image of the ROI in the current slice.

Results: Utilizing this strategy, the color slice images of the Visible Human body can be continuously and serially segmented. This method is not complex but is rapid and automatic with less manual participation.

Conclusion: The experimental results show that the primary organs of the Visible Human body can be accurately extracted.

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<![CDATA[Quantification of Collagenogenesis in Experimental Early-stage Alcoholic Liver Fibrosis using Cis-4-[18F]fluoro-L-Proline microPET]]>https://eurekaselect.com/article/1340622024-03-28Purpose: The diagnosis and quantification of early-stage alcoholic liver fibrosis (ALF) are vital and the objective is to establish a noninvasive PET technique to quantify the collagenogenesis of hepatic stellate cells (HSC) in an ALF mouse model.

Methods: To establish the ALF animal model, a liquid alcohol diet (8 weeks), and CCl4 were injected intraperitoneally at 5-8 weeks. A liquid scintillation counter was used to measure [3H]proline uptake by rats HSC in vitro experiment. Collagen type 1 production was tested by ELISA in a culture medium. The expression of type 1 collagen and proline transporters in ex vivo experiments was compared between ALF rats and mice. Different doses of unlabeled proline and benztropine were ex vivo quantified [3H]proline in liver tissues. Tracer uptake in different organs including the liver in ALF and control mice in vivo was quantified using [18F]fluoro-proline microPET/CT.

Results: The optimal dose and time of [3H]proline uptake by HSC was 19-37MBq/L and 30-90min after culture. Higher [3H]proline uptake and type 1 collagen production in HSC were found in ALF and control rats. There was a high correlation between [3H]proline uptake and type 1 collagen in ALF rats. To cut the costs of tracer usage and imaging in vivo, the mouse-to-rat model was compared. Type 1 collagen levels of ALF mice liver tissue in ex vivo were similar to ALF rats, as was proline transporter protein. Unlabeled proline of type 1 collagen and [3H]proline uptake of ALF mice was blocked by benztropine. in vivo [18F]fluoro-proline PET/CT imaging, SUVmax in the liver, normalized liver/brain and liver/thigh ratio were significantly different between ALF mice and controls and there was a strong positive correlation among these three indexes in ALF mice.

Conclusion: [18F]fluoro-proline microPET/CT is feasible to quantify collagenogenesis in HSC in early-stage ALF animal models, which may be used as a promising and reliable noninvasive diagnostic technique.

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<![CDATA[Medical Image Processing based on Generative Adversarial Networks: A Systematic Review]]>https://eurekaselect.com/article/1353752024-03-28Background: Generative adversarial networks (GANs) have demonstrated superior data generation capabilities compared to other methods, making them popular for use in medical image applications. These features have intrigued researchers in the medical imaging field, resulting in a swift implementation of these techniques in various conventional and novel applications such as image reconstruction, segmentation, detection, classification, and cross-modality synthesis. A comprehensive review of recent medical imaging breakthroughs will benefit researchers interested in this field. In this review, we aimed to introduce the origin, principle, and extended forms of GANs and summarize the state-of-the-art progress of GAN-based medical image processing methods.

Methods: We searched the literature for studies on Google Scholar and PubMed using the keywords “Segmentation,” “Classification,” “medical image,” and “generative adversarial network.” Specifically, the initial search revealed 5423 publications after the removal of duplicated and non-accessible fulltext publications. Then, after the title and abstract screening, 680 underwent full-text screening. Finally, 121 studies were included in our final analysis after full-text screening.

Results: The date range of the studies covered in this review is from January 1, 2017, to the present. After a thorough screening and qualification assessment, 121 studies involving GAN-based applications in seven areas of medical images were included in the final methodological review. These areas included synthesis, classification, segmentation, conversion, reconstruction, denoising, and lesion detection. We further classified and summarized these papers into clinical applications, classification methods, and imaging modalities.

Conclusion: We thoroughly examined the latest research progress of GAN-based medical image augmentation. These techniques effectively alleviate the challenge of limited training samples for medical image diagnosis and treatment models. Furthermore, several critical issues associated with GANs, such as pattern collapse, instability, and lack of interpretability, require attention in future research.

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<![CDATA[Automatic Kidney Stone Composition Analysis Method Based on Dual-energy CT]]>https://eurekaselect.com/article/1343622024-03-28Background The composition of kidney stones is related to the hardness of the stones. Knowing the composition of the stones before surgery can help plan the laser power and operation time of percutaneous nephroscopic surgery. Moreover, patients can be treated with medications if the kidney stone is compounded by uric acid before treatment, which can relieve the patients of the pain of surgery. However, although the literature generally reports the kidney stone composition analysis method base on dual-energy CT images, the accuracy of these methods is not enough; they need manual delineation of the kidney stone location, and these methods cannot analyze mixed composition kidney stones.

Objective This study aimed to overcome the problem related to identifying kidney stone composition; we need an accurate method to analyze the composition of kidney stones.

Methods In this paper, we proposed the automatic kidney stone composition analysis algorithm based on a dual-energy CT image. The algorithm first segmented the kidney stone mask by deep learning model, then analyzed the composition of each stone by machine learning model.

Results The experimental results indicate that the proposed algorithm can segment kidney stones accurately (AUC=0.96) and predict kidney stone composition accurately (mean Acc=0.86, mean Se=0.75, mean Sp=0.9, mean F1=0.75, mean AUC=0.83, MR (Exact match ratio)=0.6).

Conclusion The proposed method can predict the composition and location of kidney stones, which can guide its treatment.

Experimental results show that the weighting strategy can improve kidney stone segmentation performance. In addition, the multi-label classification model can predict kidney stone composition precisely, including the mixed composition kidney stones.

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<![CDATA[Assembling High-quality Lymph Node Clinical Target Volumes for Cervical Cancer Radiotherapy using a Deep Learning-based Approach]]>https://eurekaselect.com/article/1346112024-03-28Aim: The study aimed to explore an approach for accurately assembling high-quality lymph node clinical target volumes (CTV) on CT images in cervical cancer radiotherapy with the encoder-decoder 3D network.

Methods: 216 cases of CT images treated at our center between 2017 and 2020 were included as a sample, which were divided into two cohorts, including 152 cases and 64 cases, respectively. Para-aortic lymph node, common iliac, external iliac, internal iliac, obturator, presacral, and groin nodal regions were delineated as sub-CTV manually in the cohort including 152 cases. Then, the 152 cases were randomly divided into training (96 cases), validation (36 cases), and test (20 cases) groups for the training process. Each structure was individually trained and optimized through a deep learning model. An additional 64 cases with 6 different clinical conditions were taken as examples to verify the feasibility of CTV generation based on our model. Dice similarity coefficient (DSC) and Hausdorff distance (HD) metrics were both used for quantitative evaluation.

Results: Comparing auto-segmentation results to ground truth, the mean DSC value/HD was 0.838/7.7mm, 0.853/4.7mm, 0.855/4.7mm, 0.844/4.7mm, 0.784/5.2mm, 0.826/4.8mm and 0.874/4.8mm for CTV_PAN, CTV_common iliac, CTV_internal iliac, CTV_external iliac, CTV_obturator, CTV_presacral, and CTV_groin, respectively. The similarity comparison results of six different clinical situations were 0.877/4.4mm, 0.879/4.6mm, 0.881/4.2mm, 0.882/4.3mm, 0.872/6.0mm, and 0.875/4.9mm for DSC value/HD, respectively.

Conclusion: We have developed a deep learning-based approach to segmenting lymph node sub-regions automatically and assembling high-quality CTVs according to clinical needs in cervical cancer radiotherapy. This work can increase the efficiency of the process of cervical cancer detection and treatment.

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<![CDATA[Clinical Usefulness of Abbreviated MRI Protocol in Breast Cancer Detection]]>https://eurekaselect.com/article/1341292024-03-28Background: The use of breast MRI for screening has increased over the past decade, mostly in women with a high risk of breast cancer. Abbreviated breast MRI (AB-MR) is introduced to make MRI a more accessible screening modality. AB-MR decreases scanning and reporting time and the overall cost of MRI.

Objective: This study aims to evaluate the diagnostic efficacy of abbreviated MRI protocol in detecting breast cancer in screening and diagnostic populations, using histopathology as the reference standard.

Materials and Methods: This is a single-centre retrospective cross-sectional study of 134 patients with 198 histologically proven breast lesions who underwent full diagnostic protocol contrast-enhanced breast MRI (FDP-MR) at the University Malaya Medical Centre (UMMC) from 1st January 2018 to 31st December 2019. AB-MR was pre-determined and evaluated with regard to the potential to detect and exclude malignancy from 3 readers of varying radiological experiences. The sensitivity of both AB-MR and FDP-MR were compared using the McNemar test, where both protocols' diagnostic performances were assessed via the receiver operating characteristic (ROC) curve. Inter-observer agreement was analysed using Fleiss Kappa.

Results: There were 134 patients with 198 lesions. The average age was 50.9 years old (range 27 – 80). A total of 121 (90%) MRIs were performed for diagnostic purposes. Screening accounted for 9.4% of the cases, 55.6% (n=110) lesions were benign, and 44.4% (n=88) were malignant. The commonest benign and malignant lesions were fibrocystic change (27.3%) and invasive ductal carcinoma (78.4%). The mean sensitivity, specificity, positive predictive value, and negative predictive value for AB-MR were 0.96, 0.57, 0.68 and 0.94, respectively. Both AB-MR and FDP-MR showed excellent diagnostic performance with AUC of 0.88 and 0.96, respectively. The general inter-observer agreement of all three readers for AB-MR was substantial (k=0.69), with fair agreement demonstrated between AB-MR and FDP-MR (k=0.36).

Conclusion: The study shows no evidence that the diagnostic efficacy of AB-MR is inferior to FDP-MR. AB-MR, with high sensitivity, has proven its capability in cancer detection and exclusion, especially for biologically aggressive cancers.

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<![CDATA[Non-neoplastic Liver Lesions after Biliary Stenting: Gadoxetic Acid-enhanced MRI Findings and Clinical association]]>https://eurekaselect.com/article/1352322024-03-28Background: Non-neoplastic liver lesions show low signal intensity in the hepatobiliary phase (HBP) of gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) after biliary stenting and require differentiation from liver metastases.

Objective: The study aimed to evaluate the imaging findings and clinical association of non-neoplastic liver lesions showing hypointensity in the HBP of EOB-MRI after biliary stenting, and assess their differentiation from liver metastases.

Methods: This study included 30 patients who underwent EOB-MRI after biliary stenting for pancreaticobiliary malignancies. Among these, 7 patients had pathologically diagnosed non-neoplastic liver lesions, which appeared hypointense in the HBP, and were categorized into the non-neoplastic group. The remaining 23 patients without non-neoplastic liver lesions were included in the control group. Additionally, 29 patients with liver metastasis were included in the liver metastasis group. Clinical associations and imaging features were compared between the groups.

Results: A history of cholangitis and two or more biliary interventional procedures were significantly more frequently observed in the non-neoplastic group (p=0.002 and p=0.01, respectively) than in the control groups. Regarding the imaging findings, the liver-to-lesion signal intensity ratio in the HBP in the liver metastasis group was significantly higher than that in the non-neoplastic group (2.13 vs. 1.53, p=0.002). Additionally, liver metastases were visualized significantly more clearly on diffusion-weighted images (p=0.033) and HBP images (p<0.001) in comparison to non-neoplastic lesions.

Conclusion: Non-neoplastic liver lesions due to biliary inflammation may be observed in the HBP of EOB-MRI in patients after biliary stenting. These lesions may be associated with a history of cholangitis and repeated biliary intervention procedure, and need to be differentiated from liver metastases.

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<![CDATA[Contrast-enhanced Ultrasonography for Diagnosis of Small Intestinal Leiomyosarcoma with Hepatic Metastasis: A Clinical Report of One Case and Review of the Literature]]>https://eurekaselect.com/article/1354902024-03-28Background: Small intestinal leiomyosarcoma is a rare malignant tumor of the gastrointestinal tract. Clinical symptoms are atypical and can be complicated by gastrointestinal bleeding and intestinal obstruction.

Case Presentation: We report a case of a 73-year-old patient with small intestinal smooth muscle sarcoma with hepatic metastasis. No significant abnormalities were seen on examination of the abdomen. We performed abdominal enhancement CT, contrast-enhanced ultrasonography (CEUS), and ultrasoundguided pelvic mass puncture biopsy, and we found a heterogeneous density and echogenicity of the pelvic mass, and the enhancement was progressive with sustained hyperenhancement. The postoperative pathology was smooth muscle sarcoma of the small intestine. The typical fast-in, fast-out bull's-eye sign of metastases, characterized the liver presented with multiple hypodense and echogenic nodules and the enhancement. The clinical presentation, imaging, histologic features, and treatment are also discussed in this article.

Conclusion: This article briefly reviews the literature on small intestinal leiomyosarcoma. The purpose of this case report is to emphasize the specificity of the case and evaluate the imaging presentation of ultrasound (US) and CEUS and the main differential diagnosis of this rare gastrointestinal tumor.

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<![CDATA[Application of Color Doppler Ultrasound to Evaluate and Analyze the Risk Factors of Residual Stenosis after Vertebral Artery Origin Stenting]]>https://eurekaselect.com/article/1346142024-03-28Background: Vertebral artery origin stenting (VAOS) is the mainstream method for the treatment of vertebral artery stenosis (VAS). However, there are few studies on the risk factors analysis for residual stenosis after VAOS.

Purpose: This study aimed to apply color Doppler ultrasound (CDU) to evaluate and analyze the risk factors of residual stenosis after VAOS.

Methods: About 178 patients with VAOS were included from 2017 to 2019 in Liuzhou worker’s hospital and divided into the residual stenosis group (n = 38) and the no-residual stenosis group (n = 140). The clinical data and hemodynamics alteration before and after VAOS were collected. The univariate and multivariate logistic regression analysis was used to analyze the risk factors of residual stenosis.

Results: Compared with the no-residual stenosis group, the proportion of hypertension, the bending of the initial segment, and the residual stenosis length > 10 mm in the residual stenosis group were significantly higher, while the original internal diameter was significantly smaller (P < 0.05). The multivariate logistic regression analysis showed that the bending of initial segment (OR = 2.41, 95% CI: 1.32-5.45, P = 0.033), the original internal diameter (OR = 2.29, 95% CI: 1.13-5.66, P = 0.001), and the residual stenosis length > 10 mm were the risk factors of residual stenosis (OR = 2.78, 95% CI: 1.82-5.85, P = 0.044).

Conclusion: The bending of initial segment, the original internal diameter, and the residual stenosis length > 10 mm were the risk factors of residual stenosis after VAOS.

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<![CDATA[Computer-aided Diagnosis Systems for Prostate Cancer: A Comprehensive Study]]>https://eurekaselect.com/article/1319942024-03-28 <![CDATA[High-Altitude Pulmonary Edema Combined with Spontaneous Pneumomediastinum: A Case Report]]>https://eurekaselect.com/article/1352632024-03-28Background: High-altitude pulmonary edema (HAPE) is a serious life-threatening disease that occurs after rapid ascent to high altitude; its main early-stage presentations include fatigue, headache, low-grade fever, dyspnea, and cough. X-ray and computed tomography (CT) images show pulmonary shadows and patches, which may be localized (initial right lung field predomination) or generalized to the bilateral lung base.

Case Presentation: In this report, we present a case of a 25-year-old man diagnosed with HAPE combined with spontaneous pneumomediastinum. After a quick descent and effective medical treatment, this patient made a full recovery. The case may provide helpful information for the prevention and treatment of this disease since an increased number of people, especially young men, currently travel and work at high altitudes.

Conclusion: After accurate clinical diagnosis with the help of CT or X-ray, immediate descent and appropriate oxygen supplementation are the most effective treatments for HAPE at high altitude.

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<![CDATA[Reasons for Requesting Ultrasonography: A Retrospective Study]]>https://eurekaselect.com/article/1352312024-03-28Objectives: The aim of this study is to evaluate (i) the reasons for requesting ultrasonography (USG) in a dentistry faculty and (ii) the scanning regions, the type of probe used, and the use of Doppler USG.

Methods: USG request forms of patients who applied to our radiology clinic for USG were analyzed retrospectively. According to the clinical information of the patients in the request forms, the reasons for requesting USG were divided into four groups: soft tissue swelling, soft tissue calcification, lymph node, and other examinations. Data were statistically compared between sex (female and male) and age groups (≤40−years−old and ˃40−years−old).

Results: The USG request forms of 50 patients were obtained. The mean patient age was 45.06±14.50 years. Twenty-six patients were female (52%), while twenty-four patients were male (48%). Soft tissue swelling, soft tissue calcification, lymph node, and other examinations were noted as the reasons for requesting USG in 42%, 26%, 18%, and 14% of the patients, respectively. The most scanned regions were the submandibular (56%), parotid (16%), and cheek (10%) regions. Extraoral probe was used more frequently than intraoral probe (78% vs. 22%). Doppler USG was used in most patients (98%). A statistically significant difference was found between age groups and calcification examination (p<0.05).

Conclusion: The reasons for requesting USG were mostly soft tissue swelling, soft tissue calcification, and lymph node examinations. The most commonly scanned region and used type of probe were the submandibular region and extraoral probe, respectively. Doppler USG was used in most patients.

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<![CDATA[Synchronous Double Primary Malignant Tumors and their Possible Shared Genes: A Rare Clinical Entity]]>https://eurekaselect.com/article/1352362024-03-28Objective: This study sought to analyze the 18F-FDG PET/CT and contrast-enhanced computed tomography (CT) images of synchronous colorectal cancer (CRC) and renal clear cell carcinoma (ccRCC) and identify the shared genes between these two types of cancer through bioinformatic analysis.

Methods: A retrospective analysis was conducted on a patient with synchronous CRC and ccRCC who underwent 18F-FDG PET/CT and contrast-enhanced CT before treatment. Databases were analyzed to identify differentially expressed genes between CRC and ccRCC, and co-expression genes were extracted for RCC and CRC.

Results: 18F-FDG PET/CT revealed intense metabolic activity in the primary colorectal lesion (SUVmax 13.2), while a left renal mass (diameter = 35 mm) was observed with no significant uptake. Contrast-enhanced CT during the arterial phase showed heterogeneous intense enhancement of the renal lesion, and the lesion washed out earlier than in the renal cortex in the nephrographic and excretory phases, indicating ccRCC. The histopathological results confirmed synchronous double primary malignant tumors. Our bioinformatic analysis results showed that synchronous occurrence of CRC and ccRCC may correlate with simultaneous expression of Carbonic Anhydrase 9 (CA9), integrin-binding sialoprotein (IBSP), and Fibrinogen γ chain (FGG).

Conclusion: 18F-FDG PET/CT combined with contrast-enhanced CT is an effective diagnostic tool in evaluating synchronous CRC and RCC. By analyzing this clinical case and conducting bioinformatic analysis, we improved our current understanding of the mechanisms underlying synchronous tumors.

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<![CDATA[Radiological Features of Rare Non-odontogenic Lesions of the Jaws]]>https://eurekaselect.com/article/1342042024-03-28Background: The jaws can be affected by several lesions that manifest in the oral cavity, but little is known about non-odontogenic benign and malignant lesions and their radiological findings.

Introduction: Our aim was to discuss the imaging findings of non-odontogenic jaw lesions to help the surgeon in the diagnosis and formulating a differential diagnosis for this vast spectrum of jaw lesions with overlapping clinical and imaging appearances.

Methods: CT and MR images of the mandible, maxillofacial region, and neck were retrieved from the archive of the Radiology Department of Pamukkale University for the duration between 2012-2023 and assessed.

Results: A total of 8125 CT and MR images were retrospectively analyzed. The mean age of the patients was 39.5 years in females and 43.2 in males, with a range varying from 15 to 72 years. Histopathologically approved benign and malignant non-odontogenic lesions were detected in only 19 patients out of 8125 images (0.23%). Osteomyelitis and abscess were the most common (n=3; 0.03%), followed by two cases (n=2; 0.02%) of each fibrous dysplasia, hemangioma, osteosarcoma, squamous cell carcinoma, and multiple myeloma, and one case (n=1; 0.01%) of each ossifying fibroma, osteoma, lymphoma, metastasis, and solitary bone cyst.

Conclusion: Although non-odontogenic benign and malignant lesions of the jaw are rare, awareness of the radiological features of these lesions plays an important role in their diagnosis and management.

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<![CDATA[Radiomics in the Diagnosis of Gastric Cancer: Current Status and Future Perspectives]]>https://eurekaselect.com/article/1353722024-03-28 <![CDATA[Chest CT Image based Lung Disease Classification – A Review]]>https://eurekaselect.com/article/1352652024-03-28 <![CDATA[Discrepancies between Screening Sonography and Ultrasound in Emergency Department – A Case Report]]>https://eurekaselect.com/article/1354812024-03-28Introduction: This case report presents a discrepancy in sonographic findings between a screening sonography performed by a Sonographer in the Basic Emergency Service (BES) and a subsequent ultrasound performed by a Radiologist physician in a Referral Hospital (RH). The aim of this report is to discuss the possible reasons for the discrepancy and its implications for patient care.

Case Presentation: A patient with a history of epigastric pain and vomiting underwent screening sonography in a BES, which suggested Intrahepatic Biliary Dilatation Duct (IHBD) and main pancreatic duct dilatation. The patient was subsequently referred to the RH for further evaluation. However, the Radiologist in the RH did not confirm any of the initial suspicions from BES through a normal ultrasound procedure. The discrepancy raises questions regarding the quality of the screening ultrasound, misinterpretation of the BES images, or the potential for ambiguity in the point of care ultrasound (POCUS) exam.

Conclusion: The differences in sonographic findings between BES and RH, in this case, suggest that the improvement of the patient's clinical condition and therapeutic interventions may have contributed to the discrepancy. Further investigation and standardization of POCUS training and interpretation may improve diagnostic accuracy and patient outcomes.

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<![CDATA[Value of Magnetic Resonance T1 Mapping in Evaluating the Early Response to Treatment for Rheumatoid Arthritis]]>https://eurekaselect.com/article/1352342024-03-28Background: Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) is usually used for the semi-quantitative evaluation of joint changes in Rheumatoid Arthritis (RA). However, this method cannot evaluate early changes in bone marrow edema (BME).

Objective: To determine whether T1 mapping of wrist BME predicts early treatment response in RA.

Methods: This study prospectively enrolled 48 RA patients administered oral anti-rheumatic drugs. MRI of the most severely affected wrist was performed before and after 4 (48 patients) and 8 weeks of treatment (38 patients). Mean T1 values of BME in the lunate, triangular, and capitate bones; RAMRIS for each wrist; Erythrocyte-Sedimentation Rate (ESR); and 28-joint Disease Activity Score (DAS28)-ESR score were analyzed. Patients were divided into responders (4 weeks, 30 patients; 8 weeks, 32 patients) and non-responders (4 weeks, 18 patients; 8 weeks, 6 patients), according to EULAR response criteria. Receiver operating characteristic (ROC) curves were used to evaluate the efficacy of T1 values.

Results: ESR and DAS28-ESR were not correlated with T1 value and RAMRIS at each examination (P > 0.05). Changes in T1 value and DAS28-ESR relative to the baseline were moderately positively correlated with each other at 4 and 8 weeks (r = 0.555 and 0.527, respectively; P < 0.05). At 4 weeks, the change and rate of change in T1 value significantly differed between responders and non-responders (-85.63 vs. -19.92 ms; -12.89% vs. -2.81%; P < 0.05). The optimal threshold of the rate of change in T1 value at 4 weeks for predicting treatment response was -5.32% (area under the ROC curve, 0.833; sensitivity, 0.900; specificity, 0.667).

Conclusion: T1 mapping provides a new imaging method for monitoring RA lesions; changes in wrist BME T1 values reflect early treatment response.

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<![CDATA[Automatic Detection and Segmentation of Brain Hemorrhage based on Improved U-Net Model]]>https://eurekaselect.com/article/1346152024-03-28Introduction: Brain hemorrhage is one of the leading causes of death due to the sudden rupture of a blood vessel in the brain, resulting in bleeding in the brain parenchyma. The early detection and segmentation of brain damage are extremely important for prompt treatment.

Methods: Some previous studies focused on localizing cerebral hemorrhage based on bounding boxes without specifying specific damage regions. However, in practice, doctors need to detect and segment the hemorrhage area more accurately. In this paper, we propose a method for automatic brain hemorrhage detection and segmentation using the proposed network models, which are improved from the U-Net by changing its backbone with typical feature extraction networks, i.e., DenseNet-121, ResNet-50, and MobileNet-V2. The U-Net architecture has many outstanding advantages.

Results: It does not need to do too many preprocessing techniques on the original images and it can be trained with a small dataset providing low error segmentation in medical images. We use the transfer learning approach with the head CT dataset gathered on Kaggle including two classes, bleeding and non-bleeding.

Conclusion: Besides, we give some comparison results between the proposed models and the previous works to provide an overview of the suitable model for cerebral CT images. On the head CT dataset, our proposed models achieve a segmentation accuracy of up to 99%.

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<![CDATA[A New Scoring System to Differentiate Bladder Cancer from Intravesical Prostatic Protrusion in the Bladder Neck: BCa-IPP Score]]>https://eurekaselect.com/article/1360672024-03-28Objective: The aim of this study was to explore the criteria that can predict bladder cancer among the lesions that could not be differentiated from intravesical prostate protrusion (IPP) and to create a scoring system using these criteria.

Methods: A retrospective analysis was made of patients with an ultrasound report indicating lesions in the bladder neck, for which differentiation between bladder cancer and IPP could not be determined. A total of 174 patients diagnosed with bladder cancer (n=102) or benign prostate lesion (n=72) according to the biopsy results were enrolled in the study. Hemoglobin, prostate-specific antigen (PSA), prostate volume (PV), bladder wall thickness (BWT), lesion height (LH), and the ratio of lesion width to base (LW/B) were compared between the two groups.

Results: ROC analysis revealed an AUC value >0.7 for all factors, and the best cut-off value was identified for each factor. In the multivariate analysis, by determining a score for each factor according to the ORs, the BCa-IPP scoring system was developed to provide a total score in the range of minimum 0 and maximum 15. In the ROC analysis, the AUC value was 0.954 (95% CI: 0.923–0.986) for the BCa-IPP score. The best cut-off value was found to be 10, with sensitivity of 0.93 and specificity of 0.85.

Conclusion: Using simple laboratory and ultrasound findings, the BCa-IPP scoring system was created, which was seen to have high predictive value and can be easily applied in the clinic. The BCa-IPP scoring system is a non-invasive test that can be successfully applied for the differentiation of bladder cancer from benign lesions.

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<![CDATA[Age and Gender-related Morphometric Assessment and Degenerative Changes of Temporomandibular Joint in Symptomatic Subjects and Controls using Cone Beam Computed Tomography (CBCT): A Comparative Analysis]]>https://eurekaselect.com/article/1352332024-03-28Background: The temporomandibular joint diseases have been associated with various predisposing factors. Joint spaces, articular eminence height and inclination, and the shapes of the condylar and glenoid fossa have all been shown to vary in temporomandibular joint diseases (TMD) patients. Advanced imaging techniques like cone beam computed tomography (CBCT) have been employed to estimate these parameters.

Aims and Objectives: The aim of the current study was to investigate the condylar morphology, condylar and glenoid fossa shapes, and assessment of joint spaces, such as anterior, posterior, superior, lateral, and medial spaces, through CBCT slices in coronal and sagittal planes and compare them between the control group and TMD group.

Materials and Methods: A cross-sectional study was planned where 80 joints in 40 patients were assessed for the above parameters; group I consisted of healthy patients, and group II included those with temporomandibular joint diseases (TMDs). The articular eminence height and inclination were assessed on the midsagittal section. The condylar changes and shapes of the glenoid fossa and condyles, as well as the joint spaces, were assessed on the selected coronal and sagittal sections.

Results: The condylar fossa had a triangular shape in the TMJ group and an oval shape in the control group. The results were highly significant (P = 0.000**). A highly significant difference in morphological parameters, such as AJS, PJS, SJS, MJS, LJS, articular eminence height, and inclination, was found between the two groups (P = 0.000**). The association of morphological parameters, such as AJS, PJS, SJS, MJS, LJS, and articular eminence height and inclination were compared with condylar and glenoid fossa shapes, where the association of superior joint space and articular eminence inclination was observed. A highly significant difference was noted between the two groups with regard to all the parameters with P=0.00*.

Conclusion: The articular eminence inclination, as well as the superior joint space, were found to be associated with the glenoid and condyle fossa shapes in the TMJ group. These observations would, therefore, help in the early diagnosis of temporomandibular joint diseases.

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<![CDATA[Deep Learning-based Automated Knee Joint Localization in Radiographic Images Using Faster R-CNN]]>https://eurekaselect.com/article/1353742024-03-28Background: Osteoarthritis is a condition that poses a risk to the knee joint, resulting in pain and impaired function. However, traditional knee X-ray evaluations using the Kellgren-Lawrence grading system have proven to be inefficient. These evaluations are subjective, time-consuming, and labor-intensive, particularly in busy hospital settings.

Objective: The objective of this research was to present a deep learning-based approach that can detect knee joint regions in medical images. By addressing the limitations of traditional methods, the aim was to develop a more efficient and automated approach for knee joint analysis.

Methods: The proposed method utilizes the Faster R-CNN model, which consists of a region proposal network (RPN) and Fast R-CNN. The RPN generates region proposals that potentially contain knee joint regions, while the Fast R-CNN network categorizes and extracts features from these proposals. To train the model, a dataset of knee joint images was employed. The performance of the model was evaluated using metrics, such as accuracy, precision, recall, F1-score, and mean IoU (Intersection Over Union).

Results: The results demonstrated the high accuracy of the proposed method in detecting knee joint regions. The model achieved a mean IoU of 94.5, indicating a strong overlap between the predicted and ground truth regions. These findings highlight the potential of deep learning-based approaches in automating medical image analysis, specifically in the diagnosis and management of knee joint disorders.

Conclusion: This study emphasizes the significance of leveraging advanced technologies, such as deep learning, in medical imaging. By developing more efficient and accurate methods for identifying knee joint regions in medical images, it becomes feasible to enhance patient outcomes and healthcare delivery. The proposed deep learning-based approach showcases promising results, paving the way for further advancements in the field of medical image analysis and contributing to improved diagnostic capabilities for knee joint disorders.

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<![CDATA[Evaluation of Remodeling and Extrusion of Polyurethane Meniscal Implants after Meniscus Reconstruction using Ultrasonography]]>https://eurekaselect.com/article/1357622024-03-28Introduction: Meniscal tears are among the most common indications for knee arthroscopy. Artificial polyurethane scaffolds have demonstrated efficacy in reducing pain and promoting the growth of normal meniscal tissue, with high absorption rates facilitating full tissue regeneration.

Aims: This study aimed to evaluate the remodeling of polyurethane meniscal implants post-reconstruction using ultrasonography. This imaging technique not only assesses changes in implant properties, such as echogenicity, but also the shape changes during functional examination.

Methods: The assessment of meniscal extrusion, comparing size at rest and under weight-bearing, is an indirect parameter that provides insight into the physical properties of the remodeling implant, with greater extrusion indicating reduced stiffness and inferior physical properties of the meniscus. Ultrasonography has the valuable advantage of allowing for assessment of the blood supply to the meniscus through Power Doppler imaging.

Results: The presence of vessels within the meniscal implants serves as evidence of ongoing remodeling. The study included 35 patients (13 female, 22 male; mean age 41.6 years, range 18-66) who underwent arthroscopic meniscal reconstruction with polyurethane implants, with an average time from surgery of 2.8 years (range 0.3-4.5 years). Results showed complete (29.7%), significant (45.9%), or moderate (16.2%) remodeling into natural meniscal tissue in 91.8% of the implants.

Conclusion: The mean values of extrusion in the supine position and during 90-degree flexion were significantly greater in the operated limb (2.603) compared to the contralateral limb (1.978; t(35) = 2.442; P < 0.05). No significant differences in extrusion were found between the limbs in a standing position, indicating favorable physical properties of the polyurethane meniscal implants. Further ultrasonography studies of meniscal scaffolds are deemed relevant.

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<![CDATA[A Multimodal Ultrasound Observation Study on the Effect of Vitamin D on Uterine Fibroids in Non-menopausal Women]]>https://eurekaselect.com/article/1357482024-03-28Introduction: It has been reported in the literature that Vitamin D can inhibit the growth of uterine fibroids, but the evaluation index is only the size of the uterine fibroids. The purpose of this study was to evaluate the effect of vitamin D on the size, hardness, and blood flow of uterine fibroids in premenopausal women by multimodal ultrasound.

Methods: A total of 64 pre-menopausal women with uterine fibroids complicated vitamin D deficiency were enrolled in this study and randomly divided into two groups: the vitamin D group (n=32) which received oral vitamin D (1600 IU/ day) and the control group (n=32) without vitamin D supplementation. After three months of intervention, the mean diameter of uterine fibroids, elastic strain ratio, and blood flow grade were evaluated by multimodal ultrasound, and the clinical symptoms of the two groups were evaluated by questionnaire.

Results: The vitamin D group reported a significant increment in the serum 25-hydroxyvitamin D (P < 0.001). In addition, there were significant reductions in the mean diameter, and elastic strain ratio of uterine fibroids (P =.043 and P =.038, respectively), but no significant difference in the blood flow grade of uterine fibroids was observed (P =.272). Compared with the control group, the vitamin D group achieved significant relief in dysmenorrhea and frequent urination, as well as improvement in heavy menstrual bleeding.

Conclusion: The application of multimodal ultrasound provides a more comprehensive theoretical basis for vitamin on uterine fibroids. Vitamin D can effectively reduce the size of uterine fibroids in pre-menopausal women and relieve their symptoms. It is highly likely to be a promising, safe, effective, and inexpensive drug for uterine fibroids, which has good application value and promotion prospects.

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<![CDATA[Comparison of Imaging Characteristics of Gangliogliomas between Child/Adolescent Group and Adult Group]]>https://eurekaselect.com/article/1342992024-03-28Background: Ganglioglioma is a rare, slowly proliferating mixed glioneuronal tumor, with the highest incidence observed in children and young adults, but it can also occur in adults.

Objective: This study aimed to compare the imaging characteristics of ganglioglioma in children/adolescents and adults to facilitate radiographic diagnosis.

Methods: In this retrospective study, a total of 32 patients were included and divided into two groups: the child/adolescent group (age < 18 years, n=19) and the adult group (age ≥ 18 years, n=13). Various variables were analyzed, including maximum diameter, location, periphery, border, calcification, unenhanced CT attenuation, T1WI, T2WI/FLAIR, and DWI signal intensity, enhancement pattern, degree of enhancement, homogeneity of enhancement, solid/cystic component, peri-tumoral edema, intra-tumoral septa, peri-tumoral capsule, and intra-tumoral hemorrhage.

Results: Most gangliogliomas were situated in the peripheral regions, particularly in the temporal lobe. The majority exhibited hypointense/isointense signals on T1WI and hyperintense signals on T2WI/FLAIR and DWI, with predominantly heterogeneous nodular enhancement. Peri-tumoral edema was significantly less frequent in the child/adolescent group, while marked enhancement was significantly more common in the adult group. There was no significant difference in maximum diameter between the child/adolescent group and the adult group.

Conclusion: Peri-tumoral edema was significantly less prevalent in the child/adolescent group, whereas marked enhancement was significantly more frequent in the adult group. To ensure accurate results, a larger case series should be conducted to validate our findings.

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<![CDATA[Safety of Ultrasound Exposure: Awareness of Ultrasound Bioeffects among Saudi Sonographers]]>https://eurekaselect.com/article/1337192024-03-28Background: Ultrasound tends to produce biological effects on body tissues. Therefore, the application of ultrasound safety rules is needed in all ultrasound examinations to avoid bioeffects that may occur because of a high thermal index (TI) and mechanical index (MI). This study aimed to explore the Saudi sonographers' awareness of ultrasound safety and bioeffects.

Methods: A descriptive cross-sectional study was conducted, and the data was collected using an online survey google forms questionnaire disseminated through social media (Telegram, WhatsApp, and Twitter) as an electronic link. A total of 70 participants responded to the survey directly, and then, the data was analyzed using SPSS (Statistical Package for Social Science).

Results: Regarding the awareness of TI and MI, 64.3% of the participants were aware of TI and 65.7% of MI as safety ultrasound indices; moreover, 74.3% of the participants were aware of the ALARA principle “As Low as Reasonably Achievable.” Participants' knowledge concerning more heat production in pulsed Doppler ultrasound modes was poor (31.5%). Most of the sonographers, i.e, 77.1% were aware of the relationship between the risk of cavitation and MI, and 58.6% of the participants were acquainted with the current FDA output limits. In comparison, 58.6% of the participants were aware of the bioeffects of ultrasound contrast agents. There was no significant correlation between the educational level and the degree of awareness of ultrasound bioeffects and safety (P-value> 0.05).

Conclusion: In this study, it was found that sonographers were aware of the theoretical principles of ultrasound safety indices and the ALARA principle, although they had poor knowledge of ultrasound bioeffects in Doppler mode.

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<![CDATA[Applications of PET and SPECT in Patients with Autism Spectrum Disorder]]>https://eurekaselect.com/article/1352642024-03-28 <![CDATA[Transperitoneal Laparoscopic Adrenalectomy for Metachronous Contralateral Adrenal Metastasis from Oligometastatic Renal Cell Cancer: Case Report and Review of the Literature]]>https://eurekaselect.com/article/1354912024-03-28Background: The definition of oligometastasis is still controversial. Cytoreductive nephrectomy and metastasectomy are important approaches in selected patients with oligometastasis for improving survival. We aimed to present our laparoscopic metastasectomy experience in a rare case of contralateral adrenal metastasis in an oligometastatic kidney tumor.

Case Report: A 52-year-old male patient was admitted to our clinic with the diagnosis of an incidental right renal mass. On contrast-enhanced abdominal CT revealed a mass reaching approximately 8 cm in diameter in the right kidney located in the middle pole. On contrast-enhanced thorax, CT showed a metastatic lesion in the left main bronchus bifurcation. The patient underwent an open radical nephrectomy with the diagnosis of an oligometastatic right renal mass. His pathology was reported as clear cell renal cell carcinoma (ccRCC). The patient was referred to the medical oncology clinic for immunotherapy. The metastatic lesion in the lung completely regressed in the follow-up of the patient who was started on Chek point inhibitors. However, he was referred to our clinic after an incidental metachronous mass was detected in the contralateral left adrenal in FDG PET/CT (SUVmax: 6.7) in 1st year. Dynamic contrast-enhanced MRI was performed to reevaluate and for mass characterization, and a 4 cm mass was observed in the left contralateral adrenal. Laparoscopic metastasectomy was performed for the left adrenal mass. No recurrence or adrenal insufficiency developed in the 6-month follow-up after discharge.

Conclusion: Transperitoneal adrenalectomy is a minimally invasive method that can be safely performed in metastatic adrenal masses. Although contralateral adrenal metastasis is rare in ccRCC, it should be kept in mind that adrenal metastasis may develop in the late period in patients with a history of renal cancer.

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<![CDATA[CAD System Design for Pituitary Tumor Classification based on Transfer Learning Technique]]>https://eurekaselect.com/article/1355162024-03-28Background: A brain tumor is an asymmetrical expansion by cells inevitably emulating amid them. Image processing is a vibrant research area where the handing out of the image in the medical field is an exceedingly tricky field. In this paper, an expert algorithm is suggested for the detection of pituitary brain tumors from MR images.

Methods: The preprocessing techniques (smoothing, edge detection, filtering) and segmentation techniques (watershed) are applied to the online data set. The transfer learning technique is used as a classifier whose performance is measured in terms of classification accuracy. Resnet 50, Inception V3VGG16, and VGG19 models are used as classification algorithms. The proposed model is validated using different machine learning techniques considering hybrid features.

Results: 96% accuracy was obtained employing the Inception V3 model & 95% accuracy was attained using hybrid GLDS and GLCM features employing Support Vector Machine algorithm while 93% was attained using Probabilistic Neural Network and k Nearest Neighbor techniques.

Conclusion: Computer-aided systems gave much faster and more accurate results than image processing techniques.1.0% accuracy improvement was observed while using Inception V3 over GLDS + GLCM + SVM and 2.1% accuracy improvement using GLDS + GLCM + SVM over GLDS + GLCM + kNN.

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<![CDATA[Efficacy of Bronchial Artery Embolization for Clinically Suspected Bronchial Dieulafoy’s Disease]]>https://eurekaselect.com/article/1359422024-03-28Background: The efficacy of bronchial artery embolization (BAE) for bronchial Dieulafoy’s disease (BDD) has not been well established.

Objective: This study aimed to evaluate the safety and efficacy of BAE in patients with clinically suspected BDD presenting with major hemoptysis, and to describe angiographic findings.

Methods: 17 patients (all men; mean age, 53.5 years) diagnosed with clinically suspected BDD by bronchoscopy (n = 7) or CT angiography (CTA) (n = 10) and who underwent BAE after directional and segmental localization of the target bronchus were enrolled. BAE was performed at the culprit bronchial artery traveling toward the target bronchus, regardless of the pathologic angiographic findings. Angiographic findings and clinical outcomes of BAE, including technical and clinical success, complication, recurrent hemoptysis, and follow-up imaging, were retrospectively reviewed.

Results: Representative angiographic findings included parenchymal hypervascularity prominent in the lobe where the BDD was located (82.4%), bronchial artery hypertrophy (70.6%), and contrast extravasation into the bleeding bronchus (17.6%). BAE was technically successful in all patients. All hemoptysis ceased within 24 h. No procedure-related complications occurred. During a mean follow-up of 491.9 days, 1 (6%) patient experienced recurrent hemoptysis. Follow-up bronchoscopy or CT performed in 10 (58.8%) patients showed the disappearance of pre-existing lesions (n = 9) or glue cast within the target bronchial artery (n = 1).

Conclusion: Bronchial angiography showed pathologic findings in most patients with clinically suspected BDD. BAE assisted by bronchoscopy or CTA localization is a safe and effective treatment for patients with clinically suspected BDD with excellent short- to mid-term results.

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<![CDATA[A Preliminary Study of Brain Functional Magnetic Resonance Imaging in Text Reading and Comprehension]]>https://eurekaselect.com/article/1343052024-03-28Background: Few studies have focused on the changes in human brain function activities caused by reading Chinese characters with different intelligibility and whether it can reflect the understanding and cognitive ability of the human brain.

Objective: Task-fMRI based on Chinese character reading tasks with different intelligibility was used to explore activated brain regions and their cognitive changes.

Methods: Volunteers were randomly recruited using advertisements. Forty volunteers were recruited based on strict inclusion and exclusion criteria, and 40 volunteers were recruited. Brain function data of 40 healthy right-handed volunteers in fuzzy/clear Chinese reading tasks were collected using a Siemens Skyra 3.0T magnetic resonance scanner. Data were preprocessed and statistically analyzed using the statistical software SPM12.0 to observe the activation of the cortex and analyze its characteristics and possible changes in cognitive function.

Results: Task-fMRI analysis: (1) The main brain regions activated in fuzzy/clear reading tasks were located in the occipital visual cortex (P < 0.001); (2) a paired sample t-test suggested that there was a significant difference in BOLD signals in the brain regions activated by fuzzy/clear reading tasks (P < 0.001, equiv Z = 4.25). Compared with the fuzzy reading task, the brain regions more strongly activated in the clear reading task were mainly located in the right superior frontal gyrus and the bilateral temporal lobe. Compared with the clear reading task, the brain region that was more strongly activated in the fuzzy reading task was mainly located in the right fusiform gyrus.

Conclusion: Clear Chinese character information mainly activates the dorsal stream of the visual-spatial network. This reflects the information transmission of the brain after understanding the text content and is responsible for guiding and controlling attention. Fuzzy words that cannot provide clear text content activate the fusiform gyrus of the ventral stream of the visual-spatial network, strengthening the function of orthographic processing.

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<![CDATA[Breast Edema of Early-stage Invasive Ductal Carcinoma: Correlation with Axillary Lymph Node Metastasis and Clinical-pathological Characteristics]]>https://eurekaselect.com/article/1359682024-03-28Objective: This study aimed to evaluate the association of different patterns of breast edema and clinical-pathological features and axillary lymph node (ALN) status in early invasive ductal carcinoma (IDC) for simple and readily available assessment and to guide surgeons to perform sentinel lymph node biopsy for selected patients.

Materials and Methods: This retrospective analysis involved 207 individuals with clinical T1-T2 stage IDC. The clinical-pathological features of the patients were compared with different breast edema and ALN statuses. Independent risk factors for ALN metastasis were verified using multivariate logistic regression analysis.

Results: ALN metastasis was confirmed in 100 of 207 patients (48.3%) with early-stage IDC. Significant differences were found between different ALN states for tumour size, clinical T stage, and breast edema (P <0.05). The clinical T2 stage (odds ratio-1.882, p=0.043) and moderate to severe edema (odds ratio-10.869, p=0.004) were independent risk factors for ALN metastasis. Moreover, better prognostic factors, including smaller tumour size, lower Ki-67 index and histologic grade, luminal A subtype, and lower incidence of lymph node metastasis, were more frequently found in patients with no breast edema (p<0.05).

Conclusion: Breast edema can be considered a promising feature to improve the predictive performance of pathological ALN status in patients with early-stage breast cancer and thus may contribute to preoperative treatment planning.

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<![CDATA[Benign Multicystic Peritoneal Mesothelioma: Two Rare Cases and Review of the Literature]]>https://eurekaselect.com/article/1359702024-03-28Background: Benign multicystic peritoneal mesothelioma is a multiloculated cystic mass which originates from the peritoneum. This rare tumor is usually seen in women of childbearing age and has a high recurrence rate after surgery.

Case Presentation:

We present two benign multicystic peritoneal mesothelioma cases with different imaging modalities, which were also pathologically proven.

Conclusion: The imaging features which may be diagnostic should be well known as there are very few reports regarding this entity.

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<![CDATA[Subcutaneous Cavernous Haemangioma in a Patient with Klippel-Trenaunay Syndrome: A Case Report]]>https://eurekaselect.com/article/1354552024-03-28Background: Klippel-Trenaunay syndrome (KTS) is a rare congenital disease that mainly involves blood vessels and is characterized by the presence of capillary malformations (port wine stains), varicose veins, soft tissue and/or bone hypertrophy.

Case Presentation: We report a 28-year-old man who was diagnosed 20 years ago with Klippel-Trenaunay syndrome. Approximately 3 years ago, he found enlarged masses on both upper extremities and a new dark red mass that was pathologically diagnosed as cavernous haemangioma appeared on the right index finger.

Conclusion: KTS is a rare and potentially multisystem disease requiring multidisciplinary management for which imaging examination is an important auxiliary diagnostic method. Various complications may occur during its development, so regular follow-up is required to prevent serious accidents.

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<![CDATA[CT Findings of Stage IA Ovarian Cancer: Comparison with Borderline Tumor and Stage IC Ovarian Cancer]]>https://eurekaselect.com/article/1357532024-03-28Background: Ovarian cancer is a common gynecological malignant tumor in women. Most patients have reached the advanced stage when they visit the hospital. In order to diagnose ovarian cancer at an early stage, treat it at an early stage, and improve the survival rate of patients, this study has used the imaging computed tomography (CT) method to diagnose stage IA ovarian cancer.

Purpose: The purpose of this work was to study CT features of stage IA ovarian cancer, and compare the borderline tumor and stage IC ovarian cancer at the same time so as to improve the CT diagnosis of early ovarian cancer.

Methods: We retrospectively collected clinical and CT data of patients with stage I ovarian cancer and borderline ovarian tumor admitted to Nantong Tumor Hospital from 2013 to 2021. Altogether, 23 cases of patients (borderline ovarian tumor, 9 cases; stage IA ovarian cancer, 5 cases; stage IC ovarian cancer, 9 cases) were involved. CT characteristics of these patients were analyzed in terms of the tumor diameter, cystic solid structure, solid component, septation, enhancement, peritoneal thickening, ascites, and abdominal lymph nodes.

Results: CT features of stage IA ovarian cancer included large tumor size (average diameter: 15 cm), cystic solid structure (4/5; 80%), septation (4/5; 80%), and enhanced cystic wall, septum, or solid components of the tumor on contrast-enhanced CT (5/5; 100%), no peritoneal thickening (0/5; 0%), no ascites (0/5; 0%), and no abdominal lymph node enlargement (0/5; 0%). The tumor structure did not differ significantly between stage IA and IC ovarian cancers (p > 0.05), while intraperitoneal ascites did (χ2 = 0.031; p < 0.05). Stage IA and borderline ovarian tumors did not differ significantly in ovarian tumor structure (p > 0.05).

Conclusion: CT features of stage IA ovarian cancer included large tumor size, cystic solid structure, septation, and enhanced cystic wall and solid parts in the tumors. No pelvic or abdominal metastasis was observed.

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<![CDATA[Intrahepatic Pseudoaneurysm Developing at the Confluence of Bilateral Biliary Drains Six Months Following a Procedure- A Case Report]]>https://eurekaselect.com/article/1353732024-03-28Background: Hepatic artery aneurysms (HAAs) exhibit a notable risk of rupture, with both true aneurysms and pseudoaneurysms being exceptionally uncommon (incidence rate approximately 2 per 100,000). Symptoms include epigastric and right upper quadrant pain, jaundice, and potentially life-threatening bleeding upon rupture. This bleeding can extend into the portal vein, hepatic vein, biliary system, or abdominal cavity. While existing literature lacks reports of delayed post-therapeutic complications, this case report discusses a 27-year-old female who developed a pseudoaneurysm six months after bilateral biliary drain insertion, underscoring the potential for delayed complications.

Case Presentation: The patient underwent gastric endoscopy revealing an extensive lower esophageal varix protruding into the proximal stomach, subsequently treated with banding. The stomach and duodenum were found to contain fresh blood and blood clots indicating acute bleeding.

An urgent CT scan identified active bleeding (extravasation) at segment V and blood accumulation at the confluence of the right and left biliary drains. This was followed by celiac and selective hepatic digital subtraction angiography (DSA).

Conclusion: This case study outlines the occurrence of a hepatic artery pseudoaneurysm six months after percutaneous insertion of bilateral biliary drains. The pseudoaneurysm manifested precisely at the confluence of the right and left drains. The reported delayed complication may have resulted from friction between the drains at the confluence or erosion of the adjacent artery by the drains. The insights gained from this case shed light on the causes and preventive measures for potential delayed complications associated with percutaneous biliary drain placement.

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<![CDATA[A Rare Case of Castleman's Syndrome Presentıng wıth a Mass ın the Bıfurcatıon of the Celıac Trunk]]>https://eurekaselect.com/article/1354562024-03-28Introduction: Castleman's disease is an extremely rare disease in the abdomen region characterized by benign lymphoepithelial proliferation.

Case Presentation: We report a case of a 63-year-old female who presented with abdominal pain. Abdominal CT Angio and dynamic contrast-enhanced abdominal MRI revealed a mass lesion showing markedly contrast enhancement, no vascular invasion sign, and diffusion restriction lesion in the truncus coelicus bifurcation region. The mass was surgically resected completely. Pathological evaluation showed a hyaline-vascular type of Castleman’s disease.

Conclusion: Castleman's disease should be kept in mind in the differential diagnosis of an isolated intra-abdominal mass.

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<![CDATA[Multidisciplinary Management of Aneurysmal Bone Cyst in Paediatric Patients: A Case Report]]>https://eurekaselect.com/article/1355182024-03-28Background: The aneurysmal bone cyst is a benign neoplasm that tends to form the appearance of a mass with a bony septum that forms cavities with blood inside. It is estimated to represent 1% of bone tumours and has an incidence of 0.14 per 100,000 people worldwide. Current publications have not shown a multidisciplinary approach that can benefit patients, mainly in the functionality and quality of the management approach.

Objective: Describe the multidisciplinary approach and the benefits of quality of life and functionality in this diagnosis.

Case presentation: A paediatric patient was diagnosed with an aneurysmal bone cyst located in the cervical spine, which initially manifested with muscle pain, enlargement of the posterior cervical region, and difficulty in performing arcs of movement. He was treated with multidisciplinary management with surgery, embolisation, radiation, and bisphosphonate support.

Conclusion: The purpose of approaching multidisciplinary management helped to improve the accompanying symptoms that prevented our patient from having an active and quality life. However, more successful cases have not been reported to establish the best therapeutic protocol.

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<![CDATA[Prenatal Magnetic Resonance Imaging helps Discover Cerebellar Dysplasia or Malformations in Foetuses]]>https://eurekaselect.com/article/1357592024-03-28Objective: This study aimed to characterize and assess the diagnostic value of prenatal magnetic resonance (MR) imaging in detecting fetal cerebellar hypoplasia/dysplasia and developmental malformations.

Methods: Reports of suspected intracranial abnormalities were retrospectively collected on ultrasound screening (US), and MR images of fetuses were reviewed at our institution over a 5-year period on picture archiving and communication system (PACS) servers. Two experienced radiologists recorded major abnormalities and coexisting abnormalities at the reading of the census. The results of the MRI were compared against the US in each case.

Results: For prenatal MR imaging, we enlisted a total of 121 patients (mean gestational week, 24.5 ± 4.7 weeks). This included 28 cases with normal findings of MR imaging, 62 cases with findings of cerebellar hypoplasia or dysplasia, and the remaining 31 cases with other abnormities findings. Cerebral malformations cases included agenesis of the corpus callosum, cerebral hemorrhage, hydrocephalus, holoprosencephaly, ventriculomegaly, and brainstem/gyri malformation. Cerebellar abnormalities included vermis absence, cerebellar tonsil hernia, Dandy-Walker malformation, Blake’s pouch cysts, arachnoid cysts, and intracranial hemorrhage. Other systemic malformation cases included tethered cord syndromes (9 cases), cleft lip and palate (1 case), club foot (1 case), and cardiac malformation (1 case). In 12 cases (24.5%), compared to the US, MR imaging proved the value of confirming the diagnosis and/or even yielded more findings on abnormalities.

Conclusion: Prenatal MR imaging can better visualize systemic malformations coexisting with cerebellar abnormalities. MR imaging, a complementary means to the US, can aid in prenatal counseling and treatment selection for term delivery.

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<![CDATA[Combination of Multiple MRI Parameters Related to Signal Intensity and Volume for Predicting Response to Neoadjuvant Chemoradiotherapy by Patients with Locally Advanced Rectal Cancer]]>https://eurekaselect.com/article/1363652024-03-28Background: MRI of patients with locally advanced rectal cancer (LARC) can predict the pathological complete response (pCR) to preoperative chemoradiation therapy (CRT). Our purpose was to use MRI results to evaluate the diagnostic value of combined changes in signal intensity (SI) and volume (V) of patients with LARC for predicting pCR to CRT.

Methods: This retrospective study on 100 patients with LARC analyzed clinical and imaging data that were collected from March, 2018, to March, 2020. Before and after CRT, T2-weighted (T2W), apparent diffusion coefficient (ADC), and contrast-enhanced T1-weighted (ceT1W) data were analyzed. Percent changes of V (%ΔV) and relative SI ratio (%ΔSIR) on different sequences were calculated. After CRT, patients had pathological confirmation as pCR or non-pCR. Data were analyzed using nonparametric tests and receiver operating characteristic (ROC) analysis.

Results: There were 34 pCR and 66 non-pCR patients. Except for ADC-%ΔSIR, the combined parameters and single parameters had a greater decrease in the pCR group. The combination of ADC-%ΔV and T2W-%ΔSIR had the greatest diagnostic value (AUC=0.85,cutoff=0.23%) and the combination of ADC-%ΔV% and ΔSIR had the best accuracy (89%, cutoff=44.11%). Except for T2W-%ΔV and T2W-%ΔSIR, the different sequences had moderate differences in diagnostic performance. The diagnostic performance of combined parameters or single parameters on ADC and T2W was significantly better than those on ceT1W (p<0.01).

Conclusion: All sequences except ADC-%ΔSIR provided reliable predictions of pCR, although ceT1W data had limited usefulness.

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<![CDATA[Multimodal Medical Image Fusion Utilizing Two-scale Image Decomposition via Saliency Detection]]>https://eurekaselect.com/article/1352662024-03-28Background: Modern medical imaging modalities used by clinicians have many applications in the diagnosis of complicated diseases. These imaging technologies reveal the internal anatomy and physiology of the body. The fundamental idea behind medical image fusion is to increase the image's global and local contrast, enhance the visual impact, and change its format so that it is better suited for computer processing or human viewing while preventing noise magnification and accomplishing excellent real-time performance. Objective: The top goal is to combine data from various modal images (CT/MRI and MR-T1/MR-T2) into a solitary image that, to the greatest degree possible, retains the key characteristics (prominent features) of the source images.

Methods: The clinical accuracy of medical issues is compromised because innumerable classical fusion methods struggle to conserve all the prominent features of the original images. Furthermore, complex implementation, high computation time, and more memory requirements are key problems of transform domain methods. With the purpose of solving these problems, this research suggests a fusion framework for multimodal medical images that makes use of a multi-scale edge-preserving filter and visual saliency detection. The source images are decomposed using a two-scale edge-preserving filter into base and detail layers. Base layers are combined using the addition fusion rule, while detail layers are fused using weight maps constructed using the maximum symmetric surround saliency detection algorithm.

Results: The resultant image constructed by the presumed method has improved objective evaluation metrics than other classical methods, as well as unhindered edge contour, more global contrast, and no ringing effect or artifacts.

Conclusion: The methodology offers a dominant and symbiotic arsenal of clinical symptomatic, therapeutic, and biomedical research competencies that have the prospective to considerably strengthen medical practice and biological understanding.

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<![CDATA[Differences in the Fat Attenuation Index Ratio of Pericoronary Adipose Tissue And Aortic Root Epicardial Adipose Tissue in Various Plaques]]>https://eurekaselect.com/article/1357542024-03-28Background: The fat attenuation index (FAI) of pericoronary adipose tissue is associated with coronary inflammatory reactions.

Objective: This study aimed to analyze the difference in the FAI ratio between pericoronary adipose tissue volume and aortic root epicardial adipose tissue volume (AO-EATV) using computed tomography (CT) in various plaques.

Methods: In total, 645 coronary artery CT angiogram images from 215 patients were collected. The types and number of coronary plaques were recorded, and the plaque volume and pericoronary FAI of each branch were compared between the groups. The ratio of the FAI in branches with or without plaques to the AO-EATV was determined and statistically analyzed between the groups.

Results: No significant difference in the plaque volume among the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) (P > 0.05) as well as in the FAI was observed among various plaque groups (P > 0.05). FAI[LAD]/AO-EATV was in the following order: noncalcified plaques (0.70 ± 0.06) < mixed plaques (0.72 ± 0.06) < calcified plaques (0.73 ± 0.08) < no plaques (0.74 ± 0.07); FAI[LCX]/AOEATV was in the following order: noncalcified plaques (0.71 ± 0.06) < mixed plaques (0.72 ± 0.08) < calcified plaques (0.73 ± 0.09) < no plaques (0.74 ± 0.06); and FAI[RCA]/AO-EATV was in the following order: noncalcified plaques (0.71 ± 0.06) < mixed plaques (0.73 ± 0.07) < calcified plaques (0.74 ± 0.07) < no plaques (0.75 ± 0.09); the differences were statistically significant in each group (P = 0.041, 0.043, and 0.028, respectively).

Conclusion: Compared to simply comparing FAI, FAI/AO-EATV varied in the coronary arteries in various plaque groups. FAI/AO-EATV was lower in noncalcified or mixed plaques and was associated with coronary inflammatory reactions.]]> <![CDATA[Bibliometric and Visualized Analysis of Global Evolution of Research in Lung Ultrasound: A Rapidly Developing Field]]>https://eurekaselect.com/article/1355762024-03-28Background: Lung ultrasound (LUS) is gaining recognition as an indispensable diagnostic tool in critical care.

Objective: The study aimed to characterize the global research landscape and trend of LUS with quantification and visualization approaches.

Methods: Documents related to LUS published between 2007 and 2023 were selected from the Web of Science Core Collection and identified. Visualization and statistical analysis were conducted with the VOSviewer 1.6.18, CiteSpace 5.7.R5, and Bibliometrix 4.1.0 Package, including analysis of the trend of global publications, prominent countries, active institutions, and funding agencies, key authors and journals, co-cited references, and keywords.

Results: A total of 3010 publications, including 2434 articles and 576 reviews, were retrieved. The output of LUS-related research has increased steadily over the years, especially after 2018. Italy (n=756; 25.12%) has shown the highest output, being the country with the highest total citations (23423 times). The most influential author was Gargani Luna with 52 documents, who worked at the Consiglio Nazionale delle Ricerche. Chest and Intensive Care Medicine with high citations and impact factor scores were the most influential journals. Besides “lung ultrasonography”, the keywords developed included “coronavirus disease 2019 (COVID-19)”, “acute respiratory distress syndrome”, and “acute heart failure”.

Conclusion: Research output on LUS has increased steadily, especially after 2018. Italy and the United States are staying ahead in this field. Research collaboration still needs to be strengthened. This comprehensive analysis has presented the global research landscape and trends of LUS-related research, providing valuable information for researchers to pursue further exploration.

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<![CDATA[Imaging Characteristics and Pathological Analysis of Primary Hepatic Neuroendocrine Neoplasms]]>https://eurekaselect.com/article/1359402024-03-28Aims: To investigate the radiological characteristics of the PHNENs on CT and MRI and improve the understanding of the image manifestations and preoperative diagnosis of the disease.

Background: Primary hepatic neuroendocrine neoplasms (PHNENs) are rare diseases, and most of the relevant studies are case reports. Characterized by no specific clinical symptoms, PHNENs not only have a low preoperative diagnosis rate with great difficulty in early diagnosis but are frequently misdiagnosed as primary hepatic cancer.

Objective: 15 PHNEN patients were enrolled, with 10 cases in the G2 stage and 5 cases in the G3 stage.

Methods: The imaging and clinicopathological information of 15 patients pathologically diagnosed with PHNENs was retrospectively reviewed.

Results: The average age of the patients enrolled was 46.14±18.24 years, and the average tumor size was 91.00±61.17 mm. 13 cases showed nodules or masses, 8 cases were located in the periphery of the liver, showing capsule depression and subcapsular effusion signs. CT enhanced scan showed heterogeneous and obvious enhancement in 9 arterial-phase cases, 2 cases in arterial and portal venous phases both saw mild enhancement; the enhancement degree of lesions in the G2 stage in the arterial phase was significantly higher than in the G3 stage. Gd-EOB-DTPA dynamic enhanced MRI was conducted on 3 cases, and scattered lesions with heterogeneous and slight hyperintensity were observed in the hepatobiliaryspecific lesions. Image manifestations showed diffuse lesions in 2 cases, with heterogeneous enhancement in the arterial phase and decreased enhancement in the portal venous phase by the dynamic enhanced scan.

Conclusion: PHNENs were the imaging characteristics of PHNENs. The CT-enhanced scanning during the arterial phase may provide a certain reference for pathological grading (G2 and G3 grades). Gd-EOB-DTPA-enhanced MRI is helpful for PHNEN diagnosis.

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<![CDATA[Detection of Abnormality in Coronary Artery Magnetic Resonance Imaging using Bit Plane Slicing and Deep Learning]]>https://eurekaselect.com/article/1359252024-03-28Introduction: This paper presents a novel approach for detecting abnormality in coronary arteries using MRI data in RGB images. The study evaluates the test accuracy of the weak classifiers and the test accuracy and F1 score of the strong classifier.

Methods: The method involves separating the image into information planes, including R, G, and B color space, or bit-planes, and training a VGG-like convolutional neural network model on each plane separately, referred to as a “weak classifier.” The classification results of these planes are aggregated using a proposed soft voting method, forming a “strong classifier,” with the weights for the aggregation determined by the model's performance on the training set.

Results: The results indicate that the strong classifier achieves a test accuracy and F1 score of around 68% to 74% on our private coronary artery dataset. Moreover, by aggregating the top three highest bit-plane levels in a grayscale image, the accuracy is slightly lower than that of the three color spaces but requires a significantly smaller CNN model of nearly 4M parameters.

Conclusion: The potential of bit-planes in reducing model storage costs is suggested. This approach holds promise for improving the detection of abnormalities in coronary arteries using MRI data.

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<![CDATA[Diagnosis of Benign and Malignant BI-RADS 4 Breast Masses by Contrastenhanced Ultrasound Combined with Shear Wave Elastography]]>https://eurekaselect.com/article/1357502024-03-28Background: Breast cancer, one of the most prevalent malignant tumors in females, usually occurs in the breast epithelial tissues.

Objective: The study aimed to explore the diagnostic value of contrast-enhanced ultrasound (CEUS) combined with shear wave elastography (SWE) in the diagnosis of benign and malignant breast masses in BI-RADS (Breast Imaging Reporting and Data System) 4.

Methods: Examination outcomes and clinical information of 83 patients with BI-RADS 4 breast masses were analyzed retrospectively. These included patients who received CEUS, SWE, and pathological examinations. The difference of CEUS in determining the classification of BI-RADS 4 breast masses was evaluated using histopathological outcomes of breast masses as a reference standard. The diagnostic value of CEUS, SWE, and CEUS combined with SWE in the diagnosis of benign and malignant breast masses in BI-RADS 4 was also explored.

Results: Pathological biopsy results revealed 63 malignant masses and 20 benign masses among 83 BI-RADS 4 breast masses, with a 75.9% incidence of malignant masses. After the diagnosis of BI-RADS 4 breast masses with CEUS, SWE, and CEUS+SWE, the incidence of malignancy was 56.6%, 78.3%, and 73.5%, respectively. CEUS+SWE showed higher sensitivity (93.7% vs. 81% and 68.3%), specificity (90% vs. 30% and 80%), positive predictive value (96.7% vs. 78.5% and 91.5%), negative predictive value (81.8% vs. 33.3% and 44.4%), and diagnostic coincidence rate (92.8% vs. 68.7% and 71.1%) than SWE and CEUS alone in diagnosing pathological type of breast masses. Moreover, CEUS combined with SWE exhibited a larger area under the receiver operating characteristic (ROC) curve (0.918) than SWE (0.741, p = 0.028) and CEUS (0.555, p < 0.001) alone in the diagnosis of BI-RADS 4 breast masses.

Conclusion: Overall, the diagnostic value of CEUS+SWE for the pathological type of BI-RADS is preferred over CEUS and SWE alone. CEUS+SWE showed higher values than CEUS and SWE alone in diagnosing BI-RADS 4 breast masses. Specifically, CEUS+SWE can correctly identify benign and malignant masses, reduce unnecessary trauma, and avoid misdiagnosis. In summary, CEUS combined with SWE can serve as an effective diagnostic method and avoid delaying the best treatment opportunity for some malignant lesions.

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<![CDATA[An MRI-only Three-dimensional Cephalometry Protocol based on the Integrated and Modular Architecture of the Human Head]]>https://eurekaselect.com/article/1359352024-03-28Background: Currently, three-dimensional cephalometry measurements are mainly based on cone beam computed tomography (CBCT), which has limitations of ionizing radiation, lack of soft tissue information, and lack of standardization of median sagittal plane establishment.

Objectives: This study investigated magnetic resonance imaging (MRI)-only based 3D cephalometry measurement based on the integrated and modular characteristics of the human head.

Methods: Double U-Net CycleGAN was used for CT image synthesis from MRI. This method enabled the synthesis of a CT-like image from MRI and measurements were made using 3D slicer registration and fusion.

Results: A protocol for generating and optimizing MRI-based synthetic CT was described and found to meet the precision requirements of 3D head measurement using MRI midline positioning methods reported in neuroscience to establish the median sagittal plane. An MRI-only reference frame and coordinate system were established enabling an MRI-only cephalometric analysis protocol that combined the dual advantages of soft and hard tissue display. The protocol was devised using data from a single volunteer and validation data from a larger sample remains to be collected.

Conclusion: The reported method provided a new protocol for MRI-only cephalometric analysis of craniofacial growth and development, malformation occurrence, treatment planning, and outcomes.

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<![CDATA[Imaging Classification by Column and Type of the Generalized Distal Radius Die-punch Fractures]]>https://eurekaselect.com/article/1359332024-03-28Background: Generalized distal radius die-punch fractures (GDP) can involve three columns. However, there is no three-column classification for GDP. The aim of this study was to introduce a three-column classification for GDP, and to investigate the application effect of the classification.

Methods: 613 patients with GDP accrued from January 2013 to December 2021 were classified by column and fracture type based on imaging findings. First, the GDP was categorized into single-, double-, or three-column fractures. Second, the intermediate column fractures were divided into volar, dorsal, split, collapse, or mixed types; the radial column fractures were divided into metaphyseal, articular or mixed types; and the ulnar column fractures were divided into apical or basal types of the styloid process. The intra- and inter-observer consistency between the two assessors was analyzed with kappa statistics. 227 patients with less fracture displacement were treated conservatively, whereas 386 patients with increased fracture displacement were treated surgically, and the selection of surgical approaches and fracture reduction-fixation methods was guided by the classification. The differences in incidence, gender, age, treatment methods, and functional recovery were compared among the three categories, and the characteristics of different types were observed. The wrist joint function was evaluated according to the Sarmiento-modified Gartland- Werley method.

Results: The intra- and the inter-observer kappa coefficients were obtained as ≥ 0.810. There were significant differences in the incidence (12.7%, 68.5%, and 18.8%, respectively) and age (39.8, 46.6, and 47.1 years, respectively) for single-, double- and three-column fractures (P<0.05). However, there was no significant difference in terms of gender among the three (P>0.05). The mixed, collapse, split, dorsal, and volar types accounted for 28.7%, 27.7%, 21.9%, 15.5%, and 4.5%, respectively. The metaphyseal, articular surface, and mixed types accounted for 35.9%, 33.1%, and 31.0%, respectively. The apical and base types were 81.7% and 18.3%, respectively. Among the cases of volar and dorsal types, the missed diagnosis rate of X-ray alone was 28.5%, but it was confirmed by subsequent CT. In the last follow-up of 12.2 months (range, 6 to 24 months), the excellent plus good rate was 82.7% and 82.6%, respectively, in total and among patients undergoing surgical treatment; the excellent plus good rate of the single column fractures was 96.2%, significantly higher than that of double- and three-column fractures (80.0% and 83.5%, respectively) (P<0.05). All patients with fair or poor wrist function had collapse or mixed-type intermediate column fractures.

Conclusion: Different categories/types of GDP have significant differences in terms of incidence, age, efficacy, and prognosis. Imaging classification by column and type of GDP better reflects the features and injury mechanism of the fractures with good consistency. Therefore, it has important reference value for the surgical modality and prognosis evaluation.

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<![CDATA[Investigating the Correlation between Liver Ultrasound pSWE and Portal Vein Hemodynamics: Preliminary Findings]]>https://eurekaselect.com/article/1359362024-03-28Introduction: Portal vein size and hemodynamics can be altered in patients with portal hypertension. Elastography for liver stiffness has been proposed as a potential predictor of portal hypertension. However, the relationship between liver stiffness measured using point shear wave elastography (pSWE) and portal vein diameter and Doppler parameters remains unclear. Therefore, this observational study aimed to investigate the correlation between liver ultrasound pSWE and portal vein hemodynamics in healthy participants.

Methods: Twenty-five healthy men with no underlying medical conditions and who were not on regular medications were enrolled in the study. Liver stiffness, portal vein diameter, and Doppler parameters were measured using ultrasound EPIQ Elite with a curved-array transducer (C5-1 MHz) equipped with pSWE and Doppler imaging. Real-time pSWE measurements were taken from the liver. Portal vein diameter and Doppler parameters were measured in a longitudinal view of the extra-hepatic segment. Spearman correlation was used to assess the association between liver pSWE and portal vein diameter as well as Doppler parameters, with a significance level set at < 0.05.

Results: There was no significant correlation between liver stiffness and portal vein diameter (p = 0.67) or Doppler parameters, including peak systolic velocity (p = 0.89), end-diastolic velocity (p = 0.65), and resistive index (p = 0.86).

Conclusion: Our findings suggest no direct correlation between liver stiffness measured using pSWE and portal vein hemodynamics in healthy adults. Further studies are warranted to investigate the relationship between liver pSWE and the hemodynamics of portal veins in patients with liver diseases.

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<![CDATA[Blend U-Net: Redesigning Skip Connections to Obtain Multiscale Features for Lung CT Images Segmentation]]>https://eurekaselect.com/article/1359372024-03-28Background: Lung cancer is a pervasive and persistent issue worldwide, with the highest morbidity and mortality among all cancers for many years. In the medical field, computer tomography (CT) images of the lungs are currently recognized as the best way to help doctors detect lung nodules and thus diagnose lung cancer. U-Net is a deep learning network with an encoder-decoder structure, which is extensively employed for medical image segmentation and has derived many improved versions. However, these advancements do not utilize various feature information from all scales, and there is still room for future enhancement.

Methods: In this study, we proposed a new model called Blend U-Net, which incorporates nested structures, redesigned long and short skip connections, and deep supervisions. The nested structures and the long and short skip connections combined characteristic information of different levels from feature maps in all scales, while the deep supervision learning hierarchical representations from all-scale concatenated feature maps. Additionally, we employed a mixed loss function to obtain more accurate results.

Results: We evaluated the performance of the Blend U-Net against other architectures on the publicly available Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI) dataset. Moreover, the accuracy of the segmentation was verified by using the dice coefficient. Blend U-Net with a boost of 0.83 points produced the best outcome in a number of baselines.

Conclusion: Based on the results, our method achieves superior performance in terms of dice coefficient compared to other methods and demonstrates greater proficiency in segmenting lung nodules of varying sizes.

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<![CDATA[The Enhancement of Hepatic Parenchyma and Portal Vein in different CLD Groups: A Comparative Study of Gadoxetic Acid and Gadopentetate Dimeglumine]]>https://eurekaselect.com/article/1365272024-03-28Background: Chronic liver disease (CLD) will affect the enhancement of hepatic parenchyma and portal vein on abdominal-enhanced MRI.

Objective: To investigate the difference in liver parenchyma and portal vein enhancement in patients with CLD of different liver function grades between Gd- EOB-DTPA and Gd-DPTA in the portal venous phase (PVP).

Methods: This retrospective study included 218 patients with CLD who had undergone abdominal enhanced MRI from January 2019 to June 2020. Patients with various degrees of liver dysfunction were identified with Child-Turcotte-Pugh and albumin-bilirubin grade. Two readers measured the precontrast and PVP signal intensities of liver parenchyma, portal vein, spleen, and psoas muscle. Relative liver enhancement, liver-to-spleen contrast index, portal vein image contrast, and portal vein-to-liver contrast were calculated.

Results: The relative enhancement of liver parenchyma was significantly lower for the Gd-EOB-DTPA group in any degree of liver function than the Gd- DTPA group in the PVP. The Gd-EOB-DTPA group showed significantly lower portal vein-to-liver contrast in the overall study population, CTP class B, and ALBI grade 2 patients compared to the group of Gd-DTPA at PVP. No significant difference was noted in the portal vein image contrast between the two contrast agents, regardless of CTP and ALBI grading.

Conclusion: In CLD patients, Gd-EOB-DTPA yielded lower liver parenchymal enhancement and similar portal vein image contrast compared to Gd-DTPA in the PVP. Portal vein-to-liver contrast in the Gd-EOB-DTPA group was lower in the CTP class B and ALBI grade 2 subgroups compared to the Gd- DTPA group.

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<![CDATA[Contrast-enhanced Chest Ultrasound in the Control of Transthoracic Tru-cut Needle Biopsies: A Case Report]]>https://eurekaselect.com/article/1333072024-03-28Introduction: The current article presents a clinical case of ultrasound controlled transthoracic tru-cut needle biopsy of a small metastatic lesion in the left lung, performed with contrast-enhanced ultrasonography (CEUS). The following case demonstrates a real-time interventional manipulation of a very small lesion, which was done under local anesthesia, with a minimal invasion to the patient.

Case Presentation: A 72-year-old woman is presented, hospitalized for a left-sided pleural effusion with bilateral, multiple nodulеs of different sizes in the lungs. Thoracentesis revealed data for atypical cells in the pleural fluid. The CT scan suspected a probable neoplastic process, but the subsequently performed fiberbronchoscopy couldn’t prove the existence of the same. The final diagnosis was established after ultrasound controlled transthoracic tru-cut needle biopsy of a pulmonary lesion with the application of a contrast medium.

Conclusion: The CEUS allows precise detection of the metastatic area because of its unique perfusion characteristics and ability to remain hypocontrasted after the application of the contrast medium sulfur hexafluoride. The persistence of a concomitant left-sided pleural effusion is used as an ultrasound window during the performance of the manipulation, with the successful verification of the pathology as primary pulmonary adenocarcinoma. By the application of this minimally invasive manipulation, an accurate final histological result was obtained.

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<![CDATA[A Case Report of Wire-localised Excision of Impalpable Recurrent Papillary Thyroid Carcinoma and Discussion of Wire-guided Excision in the Head and Neck Pathology]]>https://eurekaselect.com/article/1334632024-03-28Introduction/Background: Wire localisation techniques are used widely for precision surgery in many specialities. This convenient technique has not yet become mainstream in the field of head and neck surgery. With limited space and many vital structures coursing through the head and neck region, pathological nodes that are difficult to palpate can be a challenge for clinicians.

Case Presentation: A patient with a history of papillary thyroid cancer treated with surgery and radioactive iodine had a single pathological node detected on ultrasound surveillance. An isolated recurrence of papillary thyroid carcinoma was confirmed. An excisional biopsy was performed using ultrasound wire guidance to successfully remove the diseased node with minimal morbidity.

Conclusion: Wire-guided lymph node excision biopsy is a safe and effective method that can be applied to multiple pathologies. As of yet, it is not routine practice to employ this technique. Larger studies would increase the generalisability and safety profile of this technique in the head and neck region.

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<![CDATA[A Comparison of Colour Doppler Ultrasound and 2D Ultrasound as Promising Prediction Methods for the Treatment effect of Patients with Advanced Cervical Cancer]]>https://eurekaselect.com/article/1343592024-03-28Background: A number of studies have evaluated the effect of colour Doppler ultrasound in patients with cervical cancer.

Objective: This study aims to evaluate the efficacy of colour Doppler ultrasound and two-dimensional ultrasound of monitoring patients with cervical cancer.

Methods: Colour Doppler ultrasound (Experimental group) and two-dimensional ultrasound (Control group) are used to monitor cervical cancer and assess the treatment effects. PFS, CI, HR, DCR, ORR, PR, SD, PD, ROD, sensitivity, and specificity, accuracy between the two groups were collected and analyzed.

Results: A total of 50 patients are included in this study, and the results show that PFS (Experimental group (EG) 5.8±2.2 versus Control group (CG) 6.1±2.6), CI (EG 20% versus CG 16%), HR (EG0.31±0.18 versus CG 0.36±0.21), DCR (EG 80% versus CG 84%), ORR(EG 28% versus CG 36%), PR (EG 16% versus CG 20%), SD (EG 48% versus CG 56%), PD (EG 12% versus CG 16%) (EG 12% versus CG 16%), ROD(EG 44% versus CG 52%) between the two groups are >0.05, and the values of sensitivity (EG 75.6% versus CG 40.2%), specificity (EG 78.4% versus CG 43.3%), and accuracy(EG 80.5% versus CG 41.4%) between the two groups are<0.05.

Conclusion: Both Colour Doppler ultrasound and two-dimensional ultrasound are effective methods to evaluate the efficacy of concurrent chemo-radiotherapy in patients with cervical cancer.

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<![CDATA[Characteristics of Fundus Autofluorescence Imaging at 795 nm and its Correlations with Postoperative Outcomes for Idiopathic Macular Hole]]>https://eurekaselect.com/article/1340572024-03-28Background: Vitrectomy combined with internal limiting membrane (ILM) peeling or ILM inverted flap greatly improves hole closure and vision prognosis for idiopathic macular holes (IMH). The application of indocyanine green (ICG) in MH surgery increases the visibility of ILM and the safety of surgery. However, the area of ILM peeling and the state of the flap and a closed hole has not been well observed.

Aims: Fundus autofluorescence at 7935nm can show the range of ILM peeling and the state of the hole site and ILM flap by monitoring residual ICG postoperatively. However, the characteristics of fundus autofluorescence especially the site of the closed hole, and its relationship with vision prognosis have not been explored. The aim of this project was to find the autofluorescence features of the closed hole and their relation with vision.

Objectives: To investigate the characteristics of fundus autofluorescence imaging after ICG-assisted vitrectomy for IMH and to evaluate the correlations of fluorescence patterns at the MH site with visual acuity and macular anatomic outcomes.

Methods: We retrospectively evaluated 33 IMH patients (33 eyes) who underwent a 25G pars plana vitrectomy (follow-up, 6-14.5 months). ICG staining (2.5 mg/mL) was either used to remove the internal limiting membrane (ILM) or the inverted ILM flap was overlaid on the hole. After surgery, fluorescence imaging of the fundus was obtained using a scanning laser ophthalmoscope at 795 nm.

Results: On fluorescence imaging, the area of ILM peeling in all eyes showed hypofluorescence with no changes over time. The inverted ILM flap (performed in 18 eyes) was positioned on the inferior retina and exhibited early mild hyperfluorescence with blurred edges. This was gradually enhanced up to 3-6 months postoperatively and was then attenuated. MHs showed two distinct patterns on optical coherence tomography: granular (21 eyes) and patchy hyperfluorescence (12 eyes). Best-corrected visual acuity improved postoperatively in all cases (p<0.001, Z=-4.744). VA was worse in the patchy (vs. granular) hyperfluorescence cases (p=0.011, Z=-2.548).

Conclusion: The status of the ILM peeling area, ILM flap, and closed MH can be clearly observed using autofluorescence imaging at 795 nm. Fluorescence may be due to ICG staining of the ILM and accumulation in retinal pigment epithelium cells during ICG-assisted surgery. Granular hyperfluorescence at the MH site may indicate good anatomic and visual prognoses.

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<![CDATA[Diagnostic Reliability of Plain Radiography in Osteonecrosis of the Femoral Head: General Radiological Features Revised]]>https://eurekaselect.com/article/1341302024-03-28Background and Objectives: Osteonecrosis of the femoral head (ONFH) is an incapacitating disease that frequently results in the collapse of the femoral head and secondary osteoarthritis. The diagnosis and staging of this pathology, which usually rely on imaging studies, are challenging. Currently, conventional radiography is the basis of the initial diagnostic assessment. In recent decades, however, radiographs have been considered insensitive to early changes in ONFH and thus, a suboptimal diagnostic tool. Paradoxically, the imaging features of radiographs are often profuse, substantial, and characteristic. This study aimed to elucidate the real limitations of this radiologic tool by assessing the diagnostic reliability of the key radiologic features and staging.

Methods: This was a retrospective study in which radiographs from 28 idiopathic ONFH confirmed cases who underwent hip arthroplasty were analyzed by eight observers who were asked to identify the presence or absence of ONFH universally reported imaging features in AP hip radiographs.

Results: Concordance analysis revealed a poor agreement between observers for most of the assessed imaging features. Only the identification of femoral head flattening and osteoarthritis signs exhibited moderate agreement with statistical significance. In contrast, the detection of radiological osteoporosis and the loss of trabeculation showed the lowest reliability, with negative kappa coefficients.

Conclusion: There is a lack of agreement between qualified observers, even for the identification of the most characteristic ONFH radiographic features. The reliability of plain radiography for the detection of basic radiological elements is even weaker in the early stages of the disease.

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<![CDATA[The Diagnostic Value of a Nomogram Based on Clinical Imaging and MRIBased Radiomic Features in Triple-Negative Breast Cancer]]>https://eurekaselect.com/article/1354512024-03-28Objective: This study aimed to determine the utility of a radiomic nomogram combined with clinical imaging and radiomic features based on MRI for the diagnosis of triple-negative breast cancer.

Methods: Multi-parametric MRI images of 136 breast cancer patients were retrospectively analyzed, 95 cases were stratified into the training cohort, and 41 cases were selected for the test group. According to the pathological molecular typing, the patients were divided into 23 cases of triple-negative breast cancer and 113 cases of non-triple-negative breast cancer. ITK software was used to manually delineate the lesion volume region of interest (VOI), and the Pyradiomics package was used to extract radiomic features for screening and model building. The platform was then used to analyze the clinical and imaging risk factors of breast cancer to build a characteristic model separately. Finally, a radiomic nomogram was constructed by integrating the radiomic and independent clinical image features. The diagnostic performance of the model was assessed using ROC curves.

Results: Univariate and multivariate analyses showed that the menstrual cycle, glandular density, and skin thickening were risk factors for clinical imaging characteristics of triple-negative breast cancer. The Area Under the Curve (AUC) was 0.839 and 0.826 for univariate and multivariate analysis, respectively. After screening, 11 radiomic features participated in the calculation of the radiomic score, and its AUC in the test set was 0.803. Combining it further with clinical models, the AUC improved to 0.899.

Conclusion: The radiomic nomogram developed in this study has great value in the diagnosis of triple-negative breast cancer.

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<![CDATA[The Value of Radiological Imaging in Assessing Extrarenal Fat and Renal Vein Invasion in Renal Cell Carcinoma]]>https://eurekaselect.com/article/1355142024-03-28 <![CDATA[Differential Diagnosis of Benign and Malignant Pulmonary Nodules in CT Images Based on Multitask Learning]]>https://eurekaselect.com/article/1353712024-03-28Background: Artificial intelligence-based aided diagnostic systems for pulmonary nodules can be divided into subtasks such as nodule detection, segmentation, and benign and malignant differentiation. Most current studies are limited to single-target tasks. However, aided diagnosis aims to distinguish benign from malignant pulmonary nodules, which requires the fusion of multiple-scale features and comprehensive discrimination based on the results of multiple learning tasks.

Objective: This study focuses on the aspects of model design, network structure, and constraints and proposes a novel model that integrates the learning tasks of pulmonary nodule detection, segmentation, and classification under weakly supervised conditions.

Methods: The main innovations include the following three aspects: (1) a two-dimensional sequence detection model based on a ConvLSTM (Convolutional Long Short-Term Memory) network and U-shaped structure network is proposed to obtain the context space features of image slices fully; (2) a differential diagnosis of benign and malignant pulmonary nodules based on multitask learning is proposed, which uses the annotated data of different types of tasks to mine the potential common features among tasks; and (3) an optimization strategy incorporating prior knowledge of computed tomography images and dynamic weight adjustment of multiple tasks is proposed to ensure that each task can efficiently complete training and learning.

Results: Experiments on the LIDC-IDRI and LUNA16 datasets showed that our proposed method achieved a final competition performance metric score of 87.80% for nodule detection and a Dice similarity coefficient score of 83.95% for pulmonary nodule segmentation.

Conclusion: The cross-validation results of the LIDC-IDRI and LUNA16 datasets show that our model achieved 87.80% of the final competition performance metric score for nodule detection and 83.95% of the DSC score for pulmonary nodule segmentation, representing the optimal result for that dataset.

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<![CDATA[Acute Pancreatitis Obstructed by a “Stone” as the First Manifestation of Eosinophilic Gastroenteritis in AIDS: A Case Report]]>https://eurekaselect.com/article/1368892024-03-28Background: Acquired immune deficiency syndrome (AIDS) associated with eosinophilic gastroenteritis is rare. We report a case of duodenal “stone” inducing acute pancreatitis with eosinophilic gastroduodenitis in an AIDS patient.

Case Summary: A 73-year-old female AIDS patient came to the hospital with recurrent abdominal pain for 20 days. Computed tomography (CT) showed pancreatitis with exudation and a high-density shadow under the gastric antrum. Gastroscopy showed that the descending part of the duodenum was blocked by a “stone”. The mucosa of the duodenum was rough, and a red polyp was found on the gastric body. The pathology result was chronic inflammation with eosinophilic granulocytes in the duodenal mucosa and gastric body polyp.

Conclusion: When AIDS patients suffer acute pancreatitis, the possibility of eosinophilic gastroenteritis needs to be considered to enable the patient to accept timely treatment.

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<![CDATA[Clinical, Radiological, and Microbiologic Characteristics of Patients with Noncystic Fibrosis Bronchiectasis in a Tertiary Center at Jordan]]>https://eurekaselect.com/article/1368902024-03-28Background: Only a small number of the investigations that were carried out in the Middle East attempted to characterize patients with NCFB. In order to characterize patients with NCFB, as well as their etiologies, microbiological profiles, and outcomes, we therefore carried out this investigation.

Methods: This retrospective cohort study was carried out at the Jordan University Hospital (JUH), a tertiary facility located in Amman, Jordan. Non-cystic Fibrosis Bronchiectasis (NCFB) was defined as an HRCT scan typical for bronchiectasis along with a negative sweat chloride test to rule out cystic fibrosis. Patients’ data were collected by the use of Electronic Medical Records (EMR) at our institution. Frequent exacerbation was defined as more than 2 exacerbations in 1 year of the onset of the diagnosis.

Results: A total of 79 patients were included, and 54.4% of them were female. The mean and standard deviation of the patient's age was 48.61 ± 19.62. The etiologies of bronchiectasis were evident in 79.7% of the sample. Asthma, Chronic Obstructive Pulmonary Diseases (COPD), and Kartagener syndrome were the most prevalent etiologies, accounting for related illnesses in 21.8%, 21.5%, and 13.9% of the patients, respectively. The most frequent bacteria cultured in our cohort were Pseudomonas and Candida Species. Moreover, 43 patients of the study cohort were frequent exacerbators, and 5 patients died.

Conclusion: Our study supports the need to identify several bronchiectasis phenotypes linked to various causes. These findings provide information to clinicians for the early detection and treatment of bronchiectasis in Jordan.

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<![CDATA[Ultrasound-based Radiomics for Predicting Metastasis in the Lymph Nodes Posterior to the Right Recurrent Laryngeal Nerve in Patients with Papillary Thyroid Cancer]]>https://eurekaselect.com/article/1357522024-03-28Background: Dissection of the lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLNs) in papillary thyroid cancer (PTC) remains controversial.

Objective: This study aimed to determine the capability of ultrasonography (US)-based radiomics for presurgical prediction of metastasis in LN-prRLNs in PTC.

Methods: Patients were retrospectively enrolled and pathologically confirmed as LN-prRLN metastasis with PTC after surgery. Radiomic analysis based on preoperative US images with manual segmentation of targets was used to develop a radiomics model. US features described in ACR TI-RADS were collected to construct a clinical model. The Radiomics model, a combined model integrating radiomics and clinical model, were also developed for the presurgical prediction of metastasis in LN-prRLNs.

Results: A total of 570 patients, including 488 patients with non-LN-prRLN metastasis and 82 with LN-prRLN metastasis, were assessed. The 15 topperforming features finally remained significant for constructing the radiomics model. The combined model showed that US measured tumor size (OR: 1.036, P = 0.044), US suspected lateral lymph node metastasis (OR: 2.247, P = 0.009), multifocality (OR: 1.920, P = 0.021), Delphian lymph node metastasis (DLNM) (OR: 2.300, P = 0.039), VIa compartment metastasis (OR: 5.357, P = 0.000), the radiomics score (OR: 1.003, P = 0.001) were significant risk factors for predicting LN-prRLN metastasis. The combined model achieved a higher AUC of 0.849 than that of the clinical model (AUC: 0.826) and radiomics model (AUC: 0.759).

Conclusion: The US-based radiomics combined model can more effectively predict LN-prRLN metastasis in PTCs patients preoperatively. This approach had the potential to assist surgeons in decision-making regarding LN-prRLN dissection.

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<![CDATA[New Neuroimaging Findings in Patients with Molybdenum Cofactor Deficiency Type A: A Case Report and Literature Review]]>https://eurekaselect.com/article/1366592024-03-28Introduction: Molybdenum cofactor deficiency (MoCD-A) is an extremely rare autosomal recessive disease that presents with intractable seizures. The diagnosis poses challenges due to the limited number of cases reported worldwide. Magnetic resonance imaging (MRI) is a useful diagnostic tool that can detect brain injury associated with the disorder. The prognosis of MoCD-A is poor partly because most cases are initially misdiagnosed as HIE (hypoxic ischemic encephalopathy), emphasizing the need for an early and accurate diagnosis to improve quality of life and provide adequate genetic counseling to avoid new cases in the future.

Case Report: This report presents a case of molybdenum cofactor deficiency type A (MoCD-A) caused by MOCS1 gene mutations. A male newborn was admitted on the 10th day of birth due to uncontrolled seizures and feeding difficulties. Brain MRI showed severe cerebral damage with multiple foci that did not enhance upon contrast administration. The diagnosis was confirmed by genetic analysis and the patient received rehabilitation. His parents also received genetic counseling. To the best of our knowledge, this is the first reported MoCD-A case that had enhanced MR imaging with Gd-DTPA (0.1 mmol/kg). In addition, we reviewed the clinical and neuroimaging features of 25 newborns diagnosed with MoCD-A, as documented in the existing literature.

Conclusion: MRI is crucial in the diagnosis of MoCD-A. A correct diagnosis can provide the family with timely genetic counseling to prevent future cases.

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<![CDATA[Preoperative T-staging of Colorectal Cancer by Dual-energy Computed Tomography: A Retrospective Study]]>https://eurekaselect.com/article/1368932024-03-28Background: Preoperative T-staging is essential for planning optimal treatment and care for colorectal cancer (CRC).

Objective: To evaluate the accuracy of Dual-energy CT (DECT) in preoperative T-staging of CRC.

Methods: The clinical data and DECT images of 37 patients with 39 CRC lesions were retrospectively analyzed. The performance of the DECT quantitative parameters in CRC T-staging was evaluated. Postoperative pathologic results were used as a gold standard. Receiver operating characteristic curves were used to assess the diagnostic efficacy of DECT parameters. P < 0.05 was deemed significant.

Results: The overall accuracy of T-staging by DECT was 76.9%. The DECT parameters were significantly different between the T3 pericolic fat stranding, T4a pericolic fat stranding, and normal pericolic fat stranding. Arterial phase λHU had the best diagnostic performance with a cut-off value of ≥0.967, resulting in a 70.6% sensitivity and a 100% specificity in differentiating between T3 and T4a stages of CRC.

Conclusion: DECT has high accuracy in the T-staging of CRC. Arterial phase λHU has the best diagnostic performance in differentiating between T3 and T4a stages of CRC.

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<![CDATA[Prenatal Ultrasound Diagnosis and Clinical Analysis of Fetal Small Bowel Obstruction]]>https://eurekaselect.com/article/1359652024-03-28Background: Fetal small bowel obstruction (SBO) is a serious condition with high morbidity and mortality rates. Prenatal ultrasound is an important tool for detecting SBO, but the optimal cutoff value for intestinal diameter remains undefined.

Objective: This study aimed to investigate the ultrasonic characteristics of fetal SBO and determine the optimal cutoff value for intestinal diameter to enhance prenatal ultrasound diagnosis.

Methods: We retrospectively analyzed the ultrasonic characteristics and postpartum data of 76 cases diagnosed with SBO. Receiver operating characteristic (ROC) curve analysis was performed to identify the optimal cutoff value for dilated intestinal diameter.

Results: Among the 76 cases, 31 displayed the “double bubble sign” on ultrasound, with 20 cases identified as annular pancreas, 6 as duodenal atresia, and 5 as duodenal membranous stenosis. In 45 cases, the lesions were located in the jejunal or ileal segment and exhibited intestinal dilatation above the lesion site, including 27 cases of small bowel atresia, 7 cases of membranous jejunal stenosis, and 11 cases of small bowel volvulus. Out of the 76 cases, 9 showed no abnormalities after birth. ROC curve analysis determined optimal cutoff values of 17.5mm and 10.5mm for predicting “double bubble sign” lesions in the gastric and duodenal widths. For predicting small intestinal dilatation, the optimal cutoff values for dilated width and length of the intestinal tube were 11.5mm and 21.5mm, respectively, with high sensitivity and specificity.

Conclusion: Ultrasonic imaging and changes in intestinal diameter provide valuable information for prenatal diagnosis and management of SBO. Establishing these cutoff values can improve the accuracy of prenatal ultrasound diagnosis for SBO.

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<![CDATA[Differential Diagnostic Value of Two-dimensional Ultrasound Combined with Three-dimensional Ultrasound Imaging Technology for Cesarean Scar Pregnancy]]>https://eurekaselect.com/article/1368942024-03-28Background: Cesarean scar pregnancy (CSP) refers to the phenomenon in which a fertilized egg implants and develops in the scar of the uterus in a woman with a history of cesarean section.

Objective: The study aimed to explore the differential diagnostic value of two-dimensional ultrasound (2D US) combined with three-dimensional ultrasound (3D US) for CSP.

Methods: Clinical data of 89 patients with CSP admitted to our hospital from January 2022 to January 2023 were retrospectively analyzed. Of them, 65 patients met the inclusion criteria. Patients underwent 2D US, 3D US, and combined 2D and 3D US imaging. Using the clinical pathological diagnosis as the “gold standard”, the differential diagnostic value of 2D US, 3D US, and 2D US combined with 3D US for CSP was compared.

Results: The detection rate of CSP using a combined 2D US and 3D US was 98.46%, which was higher than 84.62% and 89.23% achieved with 2D US and 3D US alone, respectively (P<0.05). The pathological results showed that among 65 patients, CSP type I accounted for 24.62%, type II accounted for 55.38%, and type III accounted for 20.00%. The coincidence rate of 2D US combined with 3D US was 98.46%, which was higher than that of 2D US (83.08%) and 3D US 89.23%) alone (P<0.05). The accuracy, specificity, and sensitivity of 2D US combined with 3D US in diagnosing CSP were higher compared to the two methods alone (P<0.05).

Conclusion: The combination of 2D US and 3D US can accurately detect and classify CSP, further improving diagnostic efficiency.

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<![CDATA[Quantitative Analysis of the Impact of Different Delivery Modes on Cervical Elasticity Based on Real-time Shear Wave Imaging Technology and Artificial Intelligence]]>https://eurekaselect.com/article/1368952024-03-28Background: Real-time shear wave elastography (SWE) has emerged as a useful imaging modality for detecting the lesion location of various diseases, including cervical diseases.

Objectives: In this paper, the SWE was used to quantitatively determine the tissue hardness of the internal and external orifice of the cervix (IOC & EOC) and to relatively objectively analyze the impact of different production methods on the hardness of the cervical tissue.

Methods: A total of 48 patients were selected, and they were divided into three groups according to different production methods: control group (16 cases), cesarean section group (16 cases), and spontaneous delivery group (16 cases). Artificial intelligence has also been incorporated into this work. A deep flexible neural tree model and a new set of FNT models were proposed to assist in classifying cervical physical data in different states. The physical data was extracted as the features, and the different states were considered as category labels.

Results: There was no statistically significant difference in the elasticity of the IOC and the EOC between the groups. However, the difference in the elasticity of the IOC and the EOC within each group was statistically significant. The classification results corresponded with the results of the statistical analysis. The hardness of the EOC is generally lower than that of the IOC, and there was no significant difference in hardness between the IOC and the EOC in the three groups.

Conclusion: There is no significant difference in the cervical elasticity hardness between different delivery modes.

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<![CDATA[Differential Diagnosis of Generalized Cystic Lymphangiomatosis: A Literature Review]]>https://eurekaselect.com/article/1368962024-03-28Background: Generalized cystic lymphangiomatosis (GCL) is a rare disease characterized by the widespread proliferation of lymphatic vessels, often seen in the pediatric patient group. Imaging techniques are instrumental in revealing the extent and morphological features of the disease.

Objective: The objective of this study is to interpret the radiological findings of GCL and address the differential diagnosis between GCL and other lymphatic malformations in light of the relevant literature data.

Methods: The sample of this retrospective study consisted of six pediatric patients, four males and two females, diagnosed with GCL based on clinical, radiological, and histopathological findings between 2015 and 2022. The age of the patients at the time of diagnosis and their symptoms at admission were obtained from the hospital database. Radiological imaging findings were evaluated in detail based on the involved systems (thorax, abdomen, and musculoskeletal).

Results: The median age of the sample, 4/6 were male, was 9 years at admission (min. 3, max. 12). The most common symptom at admission was dyspnea, often accompanied by pleural effusion. Bone involvement was the most common extrathoracic finding. Abdominal involvement was primarily asymptomatic, and the spleen was the most frequently involved organ in the abdomen.

Conclusion: The diagnosis of GCL is challenging because of its rarity and overlapping diseases. Whole-body magnetic resonance imaging is a valuable tool as it reveals the typical radiological features of GCL and how far it has spread throughout the body.

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<![CDATA[Consistency of Radiological Grading of Cervical Foraminal Stenosis]]>https://eurekaselect.com/article/1359992024-03-28Background: The degree of cervical foraminal stenosis on MRI scans may be measured and categorised using the Kim or modified Kim methods. These grading scales have not previously been validated in a cohort of patients awaiting surgery.

Objectives: To establish the normal foraminal and root diameters as well as the consistency of inter and intra-rater grading using the Kim and modified Kim grading systems in pre-operative surgical patients.

Methods: Asymptomatic cervical nerve roots and foramina demonstrated on the pre-operative MRI scans of adult surgical patients with cervical radiculopathy were measured and categorised by six raters using the Kim and modified Kim grading methods. Repeat “second pass” measurements were made by the same assessors on the same images a minimum of one month later.

Results: Foraminal diameters (mm) in asymptomatic foramina were C2/C3 (mean ± SD): 4.18 ± 1.44, C3/C4 2.96 ± 1.23, C4/C5 3.02 ± 1.19, C5/C6 3.15 ± 1.33, C6/C7 3.53 ± 1.36, C7/T1 3.93 ± 1.34. Nerve root diameters were C3 3.11 ± 0.87, C4 2.95 ± 0.77, C5 2.56 ± 0.73, C6 2.26 ± 0.76, C7 2.56 ± 0.82, C8 3.83 ± 0.86.

Inter-rater consistency was kappa [95% CI]: Kim 0.01 [0.00, 0.03], modified Kim 0.08 [0.05, 0.10]. Intra-rater consistency was kappa [95% CI]: Kim 0.81 [0.77, 0.86], modified Kim 0.69 [0.62, 0.76].

Conclusion: There was poor inter-rater consistency but good intra-rater consistency when assessing the severity of foraminal stenosis on axial T2 MRI scans. Foraminal diameter was narrowest at C3/C4 and C4/C5, whereas the smallest root diameter was C5/C6. Volumetric or oblique MR may improve consistency.

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<![CDATA[Chest CT Radiomics is Feasible in Evaluating Muscle Change in Diabetes Patients]]>https://eurekaselect.com/article/1368972024-03-28Background: Non-invasive imaging methods are still lacking for the evaluation of muscle changes in diabetes.

Purpose: To investigate the feasibility of muscle CT radiomics in evaluating muscle changes in diabetes.

Materials and Methods: 60 diabetics and 60 health controls (HC) were assessed with the method of muscle CT radiomics. 93 CT images of radiomics features of the pectoralis major muscle (PMM) were obtained by using the software 3D Slicer and were then compared between diabetics and HC cases. The least absolute shrinkage and selection operator (LASSO) regression method was used to establish a prediction model. The receiver operating characteristic (ROC) curve was used to determine the performance of the model.

Results: Diabetics and HC cases differed in 19 radiomics features (P<0.05). By using the LASSO method, 6 features were finally selected. The AUC of the model in the discrimination of diabetics and HC were 0.92 and 0.90, respectively, for the training cohort and validation cohort.

Conclusion: Muscle CT radiomics is feasible in evaluating muscle changes in diabetes.

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<![CDATA[Diagnostic Efficacy of High-frequency Ultrasound (HFU) in Early Diagnosis of Congenital Hip Dysplasia]]>https://eurekaselect.com/article/1368982024-03-28Background: Hip dysplasia is one of the most prevalent disorders in children and one of the three primary congenital orthopedic deformities. Although there are numerous existing methods (e.g., CT, MRI and arthrography) for early identification of hip dysplasia, their diagnostic criteria differ widely. It is critical to establish a safe, accurate, and reliable way for early diagnosis and treatment of hip dysplasia.

Objective: This study aimed to analyze the diagnostic efficacy of high-frequency ultrasound (HFU) for congenital developmental hip dysplasia and hip dislocation and to provide a reference for the early diagnosis of congenital hip dysplasia in the future.

Methods: A total of 104 infants and children suspected of having congenital hip dislocation or developmental hip dysplasia admitted to our hospital from April 2019 to August 2022 were enrolled as study subjects. All the infants and children were subjected to HFU and X-ray examination in our hospital. The diagnostic efficacy of HFU for congenital hip dysplasia was observed using X-ray as the gold standard.

Results: HFU confirmed 79 cases of congenital hip dysplasia, while X-ray confirmed 71 cases. The sensitivity and specificity of HFU were 77.42% and 83.33%, respectively, in the diagnosis of congenital developmental hip dysplasia, 76.47% and 96.55% in the diagnosis of congenital hip dislocation, and 77.22% and 60% in the diagnosis of congenital hip abnormality, which is very close to the gold standard. According to statistics on infants and children, the majority of patients were girls, and the left joint was more likely to be affected.

Conclusion: HFU has excellent diagnostic efficiency for congenital developmental hip dysplasia and hip dislocation, which can be considered an early assessment method for congenital hip dysplasia in the future.

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<![CDATA[The Application Value of Gemstone Spectral Imaging (GSI) Combined with an 80 mm Wide-body Detector in Head-neck CTA]]>https://eurekaselect.com/article/1359642024-03-28Objective: This study aims to investigate the value of gemstone spectral imaging (GSI) combined with an 80 mm wide-body detector in head-neck CTA.

Methods: Ninety patients with head-neck CTA were prospectively selected and randomly divided into a control group and a test group, with 45 patients in each group. The control group was scanned conventionally. With a tube voltage of 100 kVp and detector width of 40 mm, a 70 ml contrast agent was injected at a flow rate of 5.0 ml/s. The test group used GSI. With a tube current fixed of 445 mAs and a detector width of 80 mm, the contrast agent was injected at a flow rate of 3.5 ml/s and 0.6 ml/kg body weight, and the 55 keV virtual monoenergetic images (VMIs) were automatically reconstructed. Finally, the target vessel CT values, background noise (BN), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective scores, contrast agent dose, CT dose index volume (CTDIvol), and dose length product (DLP) were recorded. The DLP was converted to the effective dose (ED).

Results: The target vessel CT values, BN, SNR, CNR, and subjective scores of the two groups were not statistically significant (all P > 0.05), and the image quality of both groups was the same and met the diagnostic requirements. The contrast agent dose and effective dose (ED) in the test group were approximately 44% and 26% lower than that of the control group, respectively (all P < 0.05).

Conclusion: In head-neck CTA examination, the Revolution CT GSI combined with an 80 mm wide-body detector can reduce the contrast agent dose and radiation dose while ensuring image quality.

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<![CDATA[Computer Tomography (CT)-Based Study to Investigate Feasibility and Efficacy of Thoracoscopic Surgery in the Treatment of Penetrating Chest Wall Tuberculosis]]>https://eurekaselect.com/article/1370222024-03-28Background: Chest wall tuberculosis may develop if tuberculous (TB) lesions spread through the chest wall and invade the thoracic cavity. The presence of a mass on the patient's chest wall may be the first indication of TB, and a chest CT scan can help diagnose external penetrating chest wall TB, the incursion of tuberculosis from the lungs into the chest wall.

Objective: This study examines the safety and efficacy of thoracoscopic-assisted surgery for the treatment of penetrating chest wall tuberculosis as a means of exploring novel concepts of minimally invasive surgery.

Methods: Our hospital conducted a retrospective study of 25 patients with penetrating chest wall TB who underwent thoracoscopic surgery between January 2020 and June 2021. General demographics, CT scan data linked to surgery, and postoperative patient outcomes were compared between the two groups. The data was also evaluated to determine the range of operation time and the volume of bleeding from different foci in the thoracic cavity.

Results: All procedures went well after patients took conventional antituberculosis medication for at least two weeks prior to surgery. CT scans showed that thoracoscopic surgery needed a smaller incision than traditional chest wall TB surgery, with no discernible increase in surgical time. Postoperative tube use, length of hospital stay, and blood loss were all significantly lower than they would have been with conventional surgery. In addition, thoracoscopy was associated with a significantly reduced rate of subsequent treatment. Fibrous plate development and calcification caused the longest operation times in the thoracoscopic surgery group, whereas multiple pleural tuberculomas generated the most hemorrhage. Thoracoscopic surgery usually reveals tuberculous foci hiding in the thoracic cavity.

Conclusion: Thethoracic surgery can eliminate the TB focus in the chest wall and intrathoracic while treating penetrating chest wall tuberculosis. The CT scan is a crucial part of the diagnostic process for these patients. Minor surgical trauma, low complication and recurrence rates, and good results. There is a greater distinction between the two surgical approaches for patients with penetrating chest wall TB as opposed to those with basic chest wall tuberculosis.

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<![CDATA[Development of a Mind Map-based Predictive Nursing Protocol and its Impact on the Clarity of Images in Patients Undergoing High-concentration Contrast Three-dimensional Computed Tomography Imaging of Liver Blood Vessels]]>https://eurekaselect.com/article/1370232024-03-28Objective: To explore the development of a mind map-based predictive nursing protocol and assess its impact on the quality of images in patients undergoing high-concentration contrast three-dimensional computed tomography (CT) imaging of liver blood vessels.

Methods: A total of 600 patients who were admitted to Beijing You an Hospital were chosen for this prospective study and underwent high-concentration contrast three-dimensional CT imaging of liver blood vessels between April 2021 and December 2021. The patients were divided into two groups using the digital table method, with 300 cases. The control group received conventional nursing intervention, while the research group was provided with a mind map-based predictive nursing protocol. We recorded the image quality of three-dimensional CT imaging of liver blood vessels, satisfaction scores regarding nurse examination guidance, and the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) in both groups.

Results: The research group achieved a perfect rate of 100.00% for the high-quality three-dimensional CT imaging of liver blood vessels, which was noticeably higher compared to the rate of the control group of 98.67%. Patients in the research group expressed higher satisfaction levels regarding the guidance provided by nurses, including their attitude, timeliness, accuracy, and overall satisfaction, compared to the control group. Initially, the two groups had no notable differences in the SAS and SDS scores. However, after the intervention, both groups experienced a significant decrease in SAS and SDS scores, with the research group showing an even more substantial decline.

Conclusion: Through the creation of a mind map-based predictive nursing protocol and its implementation on patients undergoing high-concentration contrast three-dimensional CT imaging of liver blood vessels, it is possible to significantly enhance the quality of CT scans, alleviate feelings of anxiety and depression, increase patient satisfaction with examination guidance by nurses, and effectively decrease the occurrences of contrast agent leakage and allergic reactions to iodine.

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<![CDATA[PET/CT Examination of Teratomas after Stem Cell Transplantation for a Spinal Cord Injury: A Case Report]]>https://eurekaselect.com/article/1370212024-03-28Background: In clinical practice, stem cell transplantation has become an effective method for treating spinal cord nerve injury. Up to now, there has been no report on teratoma caused by transplanted stem cell’s abnormal differentiation in the clinic, especially in the analysis of imaging manifestations. Therefore, this article aims to analyze the PET/CT imaging manifestations of teratoma caused by stem cell transplantation to improve the imaging diagnosing capability.

Case Presentation: A patient with a spinal cord injury who had received a stem cell transplant was examined by PET/CT on September 10th, 2020. The PET/CT images of the lesion showed irregular mixed low density on the right side of the erector spinae muscle area at the level of the cervical 3-5 vertebral body, with a maximum cross-section of 9.1×3.9 cm. The 18F-FDG metabolism of the lesion was increased, and the maximum standard uptake value (SUVmax) was 10.7. The boundary was unclear with the third cervical vertebra and cervical 3 and 4-level vertebral plates. Based on the patient’s medical history, the lesion was diagnosed as an abnormal proliferative tumor, which was consistent with the pathological examination results.

Conclusion: To date, there have been no clinical reports on teratomas caused by stem cell transplantation for spinal cord injury at home or abroad. This case report enhances the knowledge of the diagnosis and treatment methods of this type of disease and confirms the diagnostic value of PET/CT examination.

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<![CDATA[Recurred Uterine Cervical Cancer Initially Manifesting as Hemorrhagic Cyst: A Case Report]]>https://eurekaselect.com/article/1364042024-03-28Background: Recurrence of uterine cervical cancer is common and often shows a dismal prognosis. Local recurrence usually manifests as solid soft tissue lesions and has rarely been reported to have cystic lesions.

Case Presentation: Herein, we report a case of recurrent uterine cervical cancer with initial manifestation as a hemorrhagic cyst, assessed using strain sonoelastography, CT, and MRI.

Conclusion: Although cystic recurrence is uncommon, newly detected simple or complex cystic lesions should be closely monitored.

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<![CDATA[Primary Pulmonary Malignant Meningioma: A Case Report and Literature Review Focusing on Imaging Findings]]>https://eurekaselect.com/article/1370242024-03-28Background: Primary pulmonary meningioma (PPM) is an extremely rare primary tumor of the lung. The diagnosis should first exclude metastasis of central nervous system MPM by using imaging, and the final diagnosis depends mainly on the tissue pathology and immunohistochemical results. Malignant PPM is even rarer, and a clear pathological definition to distinguish between benign and malignant PPM is lacking.

Case Presentation: A 47-year-old woman was admitted to the hospital after a lung mass was found during a physical examination one month earlier. The imaging findings for this patient showed a large mass in the lower lobe of the left lung with bronchial invasion. A contrast-enhanced MRI of the brain was normal. Bronchoscopy shows a mass at the opening of the left lower basal branch, with mucosal infiltration, protrusion, and stenosis of the opening. The patient underwent radical left lung cancer surgery, and the pathology specimens stained with hematoxylin–eosin demonstrated tumor cells with the focal invasion of the bronchial cartilage. Immunohistochemical staining was positive for epithelial membrane antigen(EMA), somatostatin receptor 2 (SSTR2), progesterone receptor (PR), Ki-67 (5%–10%), CD34, and D2-40 and weakly positive for p53.The pathologic diagnosis was primary pulmonary meningioma (PPM). The tumor marker CA-125 had significantly increased in the 2 months after surgery.

Conclusion: Malignant PPM is rarer, and a clear pathological definition to distinguish between benign and malignant PPM is lacking. Potential cases should be comprehensively evaluated based on imaging, laboratory, and pathology results. A long-term regular follow-up will be required to rule out metastasis or recurrence of PPM.

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<![CDATA[The Significance of Contrast-enhanced Ultrasound in the Application of Lymphaticovenous Anastomosis]]>https://eurekaselect.com/article/1363862024-03-28Background: Lymphaticovenous anastomosis (LVA) surgery is an effective treatment for lymphedema. Accurate evaluation and localization of the superficial lymphatic vessels before the operation is crucial for the success of the operation. Contrast-enhanced ultrasound (CEUS) is a new ultrasound technology, and its clinical application value in LVA surgery has not been established.

Objective: This study aimed to assess the efficacy of CEUS in LVA surgery and provide a novel approach for the clinical assessment and localization of superficial lymphatic vessels.

Methods: Retrospective analysis of imaging and surgical data was performed on 20 LVA patients. Among them, 10 cases underwent evaluation and localization using indocyanine green (ICG) lymphatic imaging (Group A), while 10 cases were evaluated and localized using CEUS (Group B). The differences in surgical data between the two groups were compared and analyzed.

Results: All 20 patients were female (mean age, 57.7 years ± 6.3 [SD]). CEUS demonstrated superior visualization and localization of superficial lymphatic vessels. The average diameter of lymphatic vessels identified in the CEUS group was significantly greater than that in the ICG group (0.78±0.06 vs. 0.52±0.05mm; P<0.001). The duration of operation in group B was significantly shorter than that in group A (4.47±0.37 vs. 6.70±0.45mm; P<0.001). The number of anastomosed lymphatic vessels in group B was less than that in group A [5.0(4.0, 6.0) vs. 9.5 (9.0, 11.3); P<0.001].

Conclusion: CEUS can serve as a viable alternative to ICG lymphatic imaging, facilitating improved lymphatic venous anastomosis surgery.

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<![CDATA[Lung Cancer Detection from CT Images: Modified Adaptive Threshold Segmentation with Support Vector Machines and Artificial Neural Network Classifier]]>https://eurekaselect.com/article/1328972024-03-28Background: The most difficult aspect of diagnosing lung cancer is early diagnosis. According to the American Cancer Society, each year, there are around 11 million newly diagnosed instances of cancer worldwide. Radiologists often turn to Computed Tomography (CT) scans to diagnose respiratory conditions, which can reveal if lung tissue remains normal or abnormal. However, there is an increased chance of inaccuracy and delay; therefore, radiologists are concerned with the physical segmentation of nodules.

Objective: The objective of the research is to implement an advanced modified threshold segmentation and classification model for early and accurate detection of lung cancer from CT images.

Methods: Using the Support Vector Machines (SVM) classifier as well as the Artificial Neural Network (ANN) classifier, the authors propose using Modified adaptive threshold segmentation as a segmentation approach for cancer detection. Here, Lung Image Database Consortium (LIDC) datasets, a collection of CT scans, are used as the video frames in an investigation to authorize the recitation of the suggested technique.

Results: Both quantitative as well as qualitative analyses are used to analyze the segmentation function of the anticipated algorithm. Both the ANN and SVM classifiers used in the suggested technique for lung cancer diagnosis achieve world-record levels of accuracy, with the former achieving a 96.3% detection rate and the latter a 97% rate of accuracy.

Conclusion: This innovation may have a major impact on the worldwide rate of lung cancer rate due to its ability to detect lung tumors in their earliest stages when they are most amenable to being avoided and treated. This method is useful because it provides more information and facilitates quick, precise decision-making for doctors diagnosing lung cancer in their patients.

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<![CDATA[Left Ventricular Pressure Strain Loops for Evaluation of Myocardial Work in Type 2 Diabetic Patients with Hypertension]]>https://eurekaselect.com/article/1359312024-03-28Background: Type 2 diabetes mellitus (T2DM) and hypertension (HT) are the two most common underlying diseases worldwide, and they often coexist. The long-term existence of both may lead to left ventricular dysfunction. Therefore, evaluating the cardiac function of T2DM patients with HT is vital to guide treatment and improve prognosis. Left ventricular pressure strain loops (LVPSL) combine left ventricular strain and afterload, which can quantify left ventricular energy expenditure and detect left ventricular subclinical systolic dysfunction. Many studies have focused on myocardial work (MW) in uncomplicated T2DM patients or simple HT patients, but a few have focused on T2DM patients with HT.

Objective: The study aimed to evaluate the MW changes in T2DM patients with HT using LVPSL and to find independent related factors of MW parameters.

Methods: 40 T2DM patients, 35 HT patients, 40 T2DM patients with HT (T2DM+HT group), and 35 controls were enrolled. The differences between clinical data, conventional ultrasound parameters, and MW parameters were analyzed among the four groups.

Results: The global longitudinal strain (GLS) of the T2DM group, HT group, and T2DM+HT group was lower than the control group (P<0.05). The global work index (GWI) and global constructive work (GCW) in the T2DM group were lower than other groups (P<0.05). The GWI of the HT group was higher than other groups (P<0.05), while GCW was only higher than the T2DM group and T2DM+HT group (P<0.05). The GWI and GCW of the T2DM+HT group were higher than the T2DM group and were lower than the HT group(P<0.05), while there was no significant difference with the control group. HT group and T2DM+HT group had higher global work waste (GWW) (P<0.05). The global work efficiency (GWE) of the T2DM+HT group was lower than other groups (P<0.05). Systolic blood pressure (SBP) and glycosylated hemoglobin (HbA1c) were independent factors of each MW parameter.

Conclusion: LVPSL can recognize left ventricular subclinical systolic dysfunction early in patients with T2DM and HT. Compared to simple T2DM or HT, the combination of T2DM and HT had greater damage to left ventricular systolic function. SBP and HbA1c are two factors that have a considerable impact on MW parameters. The impact of afterload on MW parameters should be paid more attention to.

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<![CDATA[Diagnostic Concordance and Discrepancies in 3D TVUS and MRI of Congenital Uterine Malformations across the ASRM 2016, ASRM 2021, ESHRE/ESGE 2016, and CUME 2018]]>https://eurekaselect.com/article/1364052024-03-28Background: The classification of Congenital Uterine Malformations (CONUTA) relies on coronal imaging of the uterus using 3D TVUS and MRI. In everyday practice, radiologists and gynaecologists often struggle to confidently categorize CONUTA due to varying classification systems and the lack of worldwide consensus.

Objectives: The aim of this study was to evaluate the diagnostic concordance and discrepancies between two imaging techniques within the context of the ASRM, ESHRE/ESGE, and CUME systems.

Methods: Ninety-four patients suspected of having CONUTA underwent evaluation: 67 underwent 3D TVUS, 53 had MRI scans, and 34 were examined using both imaging techniques.

An initial cross-listing table of ASRM, ESHRE/ESGE, and CUME was created, and a flowchart schema was used to define the type of congenital uterine anomaly for each system.

The prevalence of anomalies in each system was calculated, and Fleiss’ Kappa was used to assess and determine the level of agreement.

Results: Class VI arcuate uterus was the most common form in ASRM 2016 and 2021, while the partially septate uterus predominated in the CUME 2018 and ESHRE/ESGE 2016 classification systems.

Conclusion: There is no discordance between classification systems for all fusion defects and complete septate type of absorption defects. In the ESHRE/ESGE system, nearly half of the abnormal uteruses were categorized as partially septate. However, the CUME system proved less effective in distinguishing between normal and arcuate uteruses.

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<![CDATA[Radiologists’ and Radiographers’ Perspectives on Artificial Intelligence in Medical Imaging in Saudi Arabia]]>https://eurekaselect.com/article/1363992024-03-28Introduction: Artificial intelligence (AI) in medical imaging rapidly expands regarding image processing and interpretation. Therefore, the aim was to explore radiographers’ and radiologists’ perceptions and attitudes towards AI use in medical imaging technologies in Saudi Arabia.

Methods: The survey was distributed online, and responses were collected from 173 participants nationwide. Data analysis was performed using SPSS Statistics (version 27).

Results: The participants scored an average of 1.7, 1.6, and 1.8 on a scale of 1–3 for attitudinal perspectives on clinical application and the positive and negative impact of integrating AI technology in diagnostic radiology. Lack of knowledge (43.9%) and perceived cyber threats (37.7%) were the most cited factors hindering AI implementation in Saudi Arabia.

Conclusion: The radiographers and radiologists in this study had a favorable attitude toward AI integration in diagnostic radiology; nonetheless, concerns were raised about data protection, cyber security, AI-related errors, and decision-making challenges.

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<![CDATA[Predictive Factor of Tumor Aggressiveness in Patients with Extrahepatic Cholangiocarcinoma Based on Diffusion-weighted MRI]]>https://eurekaselect.com/article/1364002024-03-28Background: Extrahepatic cholangiocarcinoma (EHCC), an exceedingly malignant neoplasm, often eludes early detection, culminating in a dire prognosis. Accurate cancer staging systems and pathological differentiation are designed to guide adjuvant interventions and predict postoperative prognoses.

Objective: This study sought to investigate the predictive capacity of DW-MRI in discerning T stages, lymph node metastasis, and pathological differentiation grades in patients with EHCC.

Methods: Eighty-five patients were pathologically diagnosed with EHCC and underwent abdominal MRI within two weeks before surgery at our hospital from Aug 2011 to Aug 2021. Tumor axial maximum area (AMA) and apparent diffusion coefficient (ADC) values for diverse T stages, N stages, and differentiation grades were retrospectively analyzed.

Results: The Mann-Whitney U test displayed significantly higher lesion AMA values (P =0.006) and lower tumor ADC values (P = 0.001) in the nodepositive group (median ADC and AMA value: 1.220×10-3 mm2/s, 82.231 mm2) than in the node-negative group (median ADC and AMA value: 1.316×10-3 mm2/s, 51.174 mm2). A tumor ADC value<1.249×10-3 mm2/s from the receiver operating characteristic curve (AUC=0.725, P=0.001) exhibited the capability to predict node-positive EHCC with a sensitivity of 64.29%, and specificity of 73.68%. Furthermore, a progressive decrease in the degree of EHCC differentiation was associated with a reduction in the tumor ADC value (P=0.000).

Conclusion: The N stage and differentiation of EHCC can be evaluated non-invasively using diffusion-weighted MRI.

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<![CDATA[Imaging Changes in Liver After Chemotherapy for Colon Cancer: A Case Report]]>https://eurekaselect.com/article/1363852024-03-28Background: Colon cancer with liver metastasis is a common occurrence in clinical practice. The presence of liver metastasis has a significant impact on the treatment strategy of patients, so the first step is to diagnose whether it is liver metastasis. Imaging is one of the auxiliary methods for diagnosing liver metastases, but due to the presence of different diseases with the same shadow, we need to be cautious when using imaging methods for the diagnosis of liver metastases.

Case Presentation: We report a 53-year-old female patient with sigmoid colon cancer and perforation who underwent a surgical operation. Three years after the operation, reexamination of the liver through computed tomography and magnetic resonance imagery scanning revealed multiple progressive liver lesions. However, the liver biopsy did not show malignant changes. Repeated analysis of the patient's liver magnetic resonance imaging revealed that multiple liver nodules were significantly enhanced in the arterial phase and that the portal vein density/signal ratio was higher than that of the liver parenchyma. The coincidence of doughnut-shaped nodules and high signal in the hepatobiliary phase, combined with the results of pathological liver puncture examination, led to nodular regenerative hyperplasia being considered as a possible diagnosis.

Conclusion: A review of the relevant literature showed that following oxaliplatin chemotherapy for colorectal cancer, it is not uncommon for doughnut-shaped nodules with obvious enhancement in the middle hepatic artery phase and high signal intensity in the hepatobiliary phase to develop. Such changes should be paid sufficient attention by radiologists.

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<![CDATA[Retracted: Deep Learning-Based Glaucoma Detection Using CNN and Digital Fundus Images: A Promising Approach for Precise Diagnosis]]>https://eurekaselect.com/article/1372142024-03-28 Bentham Science apologizes to the readers of the journal for any inconvenience this may have caused.

Bentham Science Disclaimer:

It is a condition of publication that manuscripts submitted to this journal have not been published and will not be simultaneously submitted or published elsewhere. Furthermore, any data, illustration, structure and table that have been published elsewhere must be reported, and copyright permission for reproduction must be obtained. Plagiarism is strictly forbidden, and by submitting the article for publication the authors agree that the publishers have the legal right to take appropriate action against the authors if plagiarism or fabricated information is discovered. By submitting a manuscript the authors agree that the copyright of their article is transferred to the publishers if and when the article is accepted for publication.]]> <![CDATA[An Optimal Model Combining SqueezeNet and Machine Learning Methods for Lung Disease Diagnosis]]>https://eurekaselect.com/article/1352352024-03-28Background: Artificial intelligence (AI) is rapidly evolving in healthcare, with transformative potential. AI revolutionizes medical imaging by enabling online self-diagnosis for patients and improving diagnostic accuracy for healthcare professionals. While valuable datasets aid machine learning in disease detection, challenges persist in diagnosing similar lung conditions from chest X-rays. Integrating AI into healthcare holds promise for enhanced outcomes and efficiency.

Objective: In this article, we aim to present a new AI model that solves this challenge by allowing the differentiation, diagnosis and classification of three distinct diseases, whose symptoms are very similar. The fundamental contribution is to reduce the number of parameters used while maintaining the same level of precision for use in embedded systems.

Methods: Our proposed model combines the power of the neural network using the SqueezeNet architecture with a set of machine learning algorithms as classifiers, including logistic regression, support vector machine (SVM), k-nearest neighbors (KNN), decision tree, and naive Bayes. The chest Xray dataset used in the proposed model consists of CXR images that are classified into four categories: pneumonia, tuberculosis, COVID-19, and normal cases.

Results: Our proposed model demonstrated remarkable accuracy (97,32%), precision (97,33), F1 score (97,31%), recall (97,30%), and AUC (99,40), which is close to the best model. Whereas, the number of parameters used by our model (4,6 M) is very small compared to the best model in the literature (47M).

Conclusion: The model demonstrated good classification accuracy. In addition, the proposed model has the ability to use fewer parameters, which means it requires less internal memory and computing resources.

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<![CDATA[Unsupervised Imbalanced Registration for Enhancing Accuracy and Stability in Medical Image Registration]]>https://eurekaselect.com/article/1372132024-03-28Background: Medical image registration plays an important role in several applications. Existing approaches using unsupervised learning encounter issues due to the data imbalance problem, as their target is usually a continuous variable.

Objective: In this study, we introduce a novel approach known as Unsupervised Imbalanced Registration, to address the challenge of data imbalance and prevent overconfidence while increasing the accuracy and stability of 4D image registration.

Methods: Our approach involves performing unsupervised image mixtures to smooth the input space, followed by unsupervised image registration to learn the continual target. We evaluated our method on 4D-Lung using two widely used unsupervised methods, namely VoxelMorph and ViT-V-Net.

Results: Our findings demonstrate that our proposed method significantly enhances the mean accuracy of registration by 3%-10% on a small dataset while also reducing the accuracy variance by 10%.

Conclusion: Unsupervised Imbalanced Registration is a promising approach that is compatible with current unsupervised image registration methods applied to 4D images.

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<![CDATA[Application of Machine-learning based on Radiomics Features in Differential Diagnosis of Superficial Lymphadenopathy]]>https://eurekaselect.com/article/1372122024-03-28Objective: The accurate diagnosis of superficial lymphadenopathy is challenging. We aim to explore a non-invasive and accurate machine-learning method for distinguishing benign lymph nodes, lymphoma, and metastatic lymph nodes.

Methods: The clinical data and ultrasound images of 160 patients with superficial lymphadenopathy (58 benign lymph nodes, 62 lymphoma, 40 metastatic lymph nodes) admitted to our hospital from January 2020 to November 2022 were retrospectively studied. Patients were randomly divided into a training set and test set according to the ratio of 6:4. Firstly, the radiomics features of each lymph node were extracted, and then a series of statistical methods were used to avoid over-fitting. Then, the gradient boosting machine(GBM) was used to build the model. The area under receiver(AUC) operating characteristic curve, precision, recall rate and F1 value were calculated to evaluate the effectiveness of the model.

Results: Ten robust features were selected to build the model. The AUC values of benign lymph nodes, lymphoma and metastatic lymph nodes in the training set were 1.00, 0.98 and 0.99, and the AUC values of the test set were 0.96, 0.84 and 0.90, respectively.

Conclusion: It was a reliable and non-invasive method for the differential diagnosis of lymphadenopathy based on the model constructed by machine learning.

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<![CDATA[Immunoglobulin G4-related Disease with Multiple Organs Involvement Depicted on FDG PET/CT: A Case Report and Literature Review]]>https://eurekaselect.com/article/1344612024-03-28Introduction: Immunoglobulin G4-related disease (IgG4-RD) is a relatively rare immune-mediated chronic inflammatory disease with fibrosis newly defined in recent years. It can involve multiple systems and organs with complex clinical manifestations. Due to mass-like lesions, it is easily misdiagnosed as tumors.

Case Report: Herein, we report a 57-year-old woman treated for submandibular mass and anosmia. The serum IgG4 level was increased. The biopsy of the submandibular gland indicated salivary gland tissue and hyperplasia of fibrous tissue and lymphoid tissue. Immunohistochemical examination showed a large number of IgG4-positive plasma cells. M protein was found in the patient's serum by immunofixation electrophoresis, and plasma cell diseases were excluded by bone marrow puncture. PET/CT examination showed that besides the submandibular glands, the parotid gland, common bile duct, the transitional part of the left renal pelvis and ureter, retroperitoneum in the lower abdomen, and multiple lymph nodes were also involved. The patient was diagnosed with IgG4-RD, and after treatment with glucocorticoid, the enlargement of submandibular glands and decreased olfactory function improved. After 14 weeks of treatment, the serological examinations, PET/CT, and ultrasound re-examination results showed significant improvement. So far, the patient has been followed up for 27 months and is in continuous remission.

Conclusion: This case report aims to raise awareness of IgG4-RD and explore the value of PET/CT in the diagnosis and efficacy monitoring of the disease.

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<![CDATA[The Value of Computed Tomography in Recurrent Laryngeal Cancer Following Organ Preservation Therapy]]>https://eurekaselect.com/article/1353762024-03-28Aim: This study aims to assess the accuracy of computed tomography (CT) in detecting recurrent laryngeal tumors after failed chemoradiation therapy (CRT).

Background: Local recurrence of laryngeal tumors following CRT has been reported in approximately 25%, yet it is often difficult to detect.

Methods: Ten patients with laryngeal cancer who failed CRT and subsequently underwent salvage total laryngectomy were included. The laryngeal subsites involved in the tumor were identified based on postoperative pathology. The corresponding preoperative CT scans were selected for review by seven experts (head-and-neck surgeons or radiologists) who scored the extent of tumor spread on each scan on a 5-point scale, from no tumor detected to clearly visible tumor.

Results: The rates of high tumor detectability (scores 4-5) varied according to laryngeal subsite, from 75% in the glottic region, to 45% in the subglottic region, and to 19% in the supraglottic region (P=0.01). The detectability rates were higher on scans performed 2 years or more after CRT.

Conclusion: The CT evaluation of laryngeal cancer after CRT has limited value, particularly in the epiglottis and subglottis.

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<![CDATA[Application Potential of Radiomics based on the Unenhanced CT Image for the Identification of Benign or Malignant Pulmonary Nodules]]>https://eurekaselect.com/article/1355122024-03-28Objective: With the rapid development in computed tomography (CT), the establishment of artificial intelligence (AI) technology and improved awareness of health in folks in the decades, it becomes easier to detect and predict pulmonary nodules with high accuracy. The accurate identification of benign and malignant pulmonary nodules has been challenging for radiologists and clinicians. Therefore, this study applied the unenhanced CT imagesbased radiomics to identify the benign or malignant pulmonary nodules.

Methods: One hundred and four cases of pulmonary nodules confirmed by clinicopathology were analyzed retrospectively, including 79 cases of malignant nodules and 25 cases of benign nodules. They were randomly divided into a training group (n = 74 cases) and test group (n = 30 cases) according to the ratio of 7:3. Using ITK-SNAP software to manually mark the region of interest (ROI), and using AK software (Analysis kit, Version 3.0.0.R, GE Healthcare, America) to extract image radiomics features, a total of 1316 radiomics features were extracted. Then, the minimum–redundancy–maximum–relevance (mRMR) algorithms were used to preliminarily reduce the dimension, and retain the 30 most meaningful features, and then the least absolute shrinkage and selection operator (LASSO) algorithm was used to select the optimal subset of features, so as to establish the final model. The performance of the model was evaluated by using the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), accuracy, sensitivity and specificity. Calibration refers to the agreement between observed endpoints and predictions, and the clinical benefit of the model to patients was evaluated by decision curve analysis (DCA).

Results: The accuracy, sensitivity, and specificity of the training and testing groups were 81.0%, 77.7%, 82.1% and 76.6%, 85.7%, 73.9%, respectively, and the corresponding AUCs were of 0.83 in both groups.

Conclusion: CT image-based radiomics could differentiate benign from malignant pulmonary nodules, which might provide a new method for clinicians to detect benign and malignant pulmonary nodules.

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<![CDATA[Imaging and Histopathological Features Of Primary Thymic Neuroendocrine Tumor]]>https://eurekaselect.com/article/1373992024-03-28Objectives: To investigate CT, MRI, and PET/CT features with histopathological findings of primary thymic neuroendocrine tumor.

Materials and Methods: All 9 cases with pathologically proven primary thymic neuroendocrine tumors were reviewed retrospectively. Among them, 7 underwent enhanced CT, 1 with MRI (enhanced) and another with PET/CT scan. Multiple characters were examined, including tumor location, contour, CT attenuation, enhancement pattern, involvement of surrounding structure and lymphadenopathy.

Results: Among 9 patients studied, 7 (77%) masses were located in the anterior superior mediastinum, 1 in the anterior superior-middle mediastinum, and 1 in the anterior and middle mediastinum. The maximum diameter (longitudinal) ranged from 4.2 to 23 cm (mean ± standard deviation, 9.5 cm ± 2.8). Four masses had irregular, 3 had lobulated, and 2 had smooth contours, while 8 masses had clear margins and 1 had an ill-defined margin. Six masses showed heterogeneous attenuation with necrotic/cystic component (n=5), calcification (n=2) and hemorrhage(n=1), and 3 showed homogeneous attenuation on the non-enhanced image. After contrast administration, 8 masses showed heterogeneous attenuation, and 1 showed homogeneous attenuation with tumor vessels visible in 4 masses. Among all, 8 masses showed strong enhancement, and 1 showed moderate enhancement in comparison to muscles in the anterior thoracic wall on enhanced images. Involvement of adjacent mediastinal structures was observed in 5 cases. Immunohistochemical analysis showed that the tumor cells were positive for CgA, Syn, CK, CD56 and EMA.

Conclusion: Primary NETs are large masses located anterior superior mediastinum, irregular in contour, showing heterogeneous attenuation with necrotic/cystic component and strong heterogeneous enhancement with tumor vessels, compressing local mediastinal structures. In addition, immunohistochemical examination is required in such a diagnosis.

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<![CDATA[An Evaluation Analysis for Computed Tomography Image Quality of Primary Liver Cancer Lesions Based on Deep Learning Image Reconstruction]]>https://eurekaselect.com/article/1373982024-03-28Background: Abdominal multi-slice helical computed tomography (CT) and contrast-enhanced scanning have been widely recognized clinically.

Objective: The impact of the deep learning image reconstruction (DLIR) on the quality of dynamic contrast-enhanced CT imaging of primary liver cancer lesions was evaluated through comparison with the filtered back projection (FBP) and the new generation of adaptive statistical iterative reconstruction-V (ASIR-V).

Methods: We evaluated the image noise of the lesion, fine structures inside the lesion, and diagnostic confidence in 48 liver cancer subjects. The CT values of the solid part of the lesion and the adjacent normal liver tissue and the systolic and diastolic blood pressure (SD) values of the right paravertebral muscle were measured. The muscle SD value was considered as the background noise of the image, and the signal noise ratio (SNR) and contrast signal-to-noise ratio (CNR) of the lesion and normal liver parenchyma were calculated.

Results: High consistency in the evaluation of image noise (Kappa = 0.717). The Kappa values for margin/pseudocapsule, fine structure within the lesion, and diagnostic confidence were 0.463, 0.527, and 0.625, respectively. Besides, the differences in SD, SNR and CNR data of reconstructed lesion images among the six groups were statistically significant.

Conclusion: The contrast-enhanced CT image noise of DLIR-H in the portal venous phase is much lower than that of ASIR-V and FBP in primary liver cancer patients. In terms of the lesion structure display, the new reconstruction algorithm DLIR is superior.

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<![CDATA[Morphological Correlation between the Diameters of the Left Main Coronary Artery and its Branches Measured by QCA and Derived by Finet’s Law]]>https://eurekaselect.com/article/1373962024-03-28Background: Coronary artery diseases are the leading cause of death worldwide. Stenting or angioplasty of coronary arteries as interventional management requires knowledge about the morphology of the coronary tree, including luminal diameters.

Objective: This work aimed to study the diameters of the left main coronary artery and its branches measured by QCA in relation to the diameters derived by Finet’s law.

Methods: This was a cross-sectional, retrospective, hospital-based study. The number of angiograms used was 357. The diameters of the left main coronary artery (LM1), left anterior interventricular artery (LAD1), and left circumflex artery (LCx1) were measured by QCA. The diameter of LM1 was measured by 5 mm before its termination, and the diameters of LAD1 and LCx1 were obtained by 5 mm from their origins. Finet’s law was used to calculate the diameters of LM2, LAD2 and LCx2 using the QCA measurements.

Results: The mean age of participants was 53.3±8.8 years. Female patients represented 58.9%. The mean diameter of the left main coronary using QCA was 3.75±0.85 mm, and the diameter calculated using Finet’s law was 3.89±0.80 mm. The diameters of LAD1 and LCx1 were larger than those calculated with Finet’s law. The Z-test showed a significant difference between the diameter of the LM1 calculated by Finet’s law; both diameters were positively associated. The diameters of LAD1 and LAD2 showed a non-significant correlation (r = 0.0653, P = 0.259526) and a negative correlation between LCx1 and LCX2 (r = -0.2659, P = 0.00001). The Z-test showed a significant difference in the diameter of LAD and LCx measured by QCA and Finet’s law.

Conclusion: An association was found between the diameter of LM measured by QCA and calculated with Finet’s law; the diameter calculated by Finet’s law was larger. The diameters of LAD and LCx measured by QCA were larger than those calculated by Finet’s law. A positive correlation existed between the diameters measured by QCA and Finet’s law, and they had significant differences. Finet’s law can assist in the selection of stent size. Despite the literature about Finet’s law, generalising its use requires more studies on different ethnicities.

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<![CDATA[Implication of Bone Mineral Density and Body Composition Parameters for Length of Hospital Stay in Patients with COVID-19]]>https://eurekaselect.com/article/1373972024-03-28Background: Multisystem information, including musculoskeletal information, can be captured from chest CT scans of patients with COVID-19 without further examination.

Aims: This study aims to assess the relationship between chest CT-extracted baseline bone mineral density (BMD) and body composition parameters and the length of hospital stay in these patients.

Methods: A retrospective analysis was performed in a cohort of 88 patients with COVID-19. Correlation analysis and a generalized linear model (GLM) were used to assess the associations between the length of hospital stay and covariates, including age, sex, body mass index (BMI), BMD and body composition variables.

Results: The mean length of hospital stay was 27.4±8.7 days. The length of hospital stay was significantly positively associated with age (r=0.202, p=0.046) and the paraspinal muscle fat ratio (r=0.246, p=0.021). The GLM involving age, sex, BMD, paraspinal muscle fat ratio, subcutaneous adipose tissue (SAT) area, visceral adipose tissue (VAT) area, and liver fat fraction (LFF) showed that the length of hospital stay was positively correlated with VAT area (β coefficients, 95% CI: 9.304, 1.141-17.478, p=0.025).

Conclusion: The musculoskeletal features extracted from chest CT correlated with the prognosis of COVID-19 patients. Factors including old age, a higher paraspinal muscle fat ratio and a larger VAT area in patients with COVID-19 were associated with longer hospital stays.

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<![CDATA[Machine Learning in Magnetic Resonance Images of Glioblastoma: A Review]]>https://eurekaselect.com/article/1375392024-03-28Background: The purpose of this work was to identify which Glioblastoma (GBM) problems can be handled by Magnetic Resonance Imaging (MRI) and Machine Learning (ML) techniques. Results, limitations, and trends through a review of the scientific literature in the last 5 years were performed. Google Scholar, PubMed, Elsevier databases, and forward and backward citations were used for searching articles applying ML techniques in GBM. The 50 most relevant papers fulfilling the selection criteria were deeply analyzed. The PRISMA statement was followed to structure our report.

Methods: A partial taxonomy of the GBM problems tackled with ML methods was formulated with 15 subcategories grouped into four categories: extraction of characteristics from tumoral regions, differentiation, characterization, and problems based on genetics.

Results: The dominant techniques in solving these problems are: Radiomics for feature extraction, Least Absolute Shrinkage and Selection Operator for feature selection, Support Vector Machines and Random Forest for classification, and Convolutional Neural Networks for characterization. A noticeable trend is that the application of Deep Learning on GBM problems is growing exponentially. The main limitations of ML methods are their interpretability and generalization.

Conclusion: The diagnosis, treatment, and characterization of GBM have advanced with the aid of ML methods and MRI data, and this improvement is expected to continue. ML methods are effective in solving GBM-related problems with different precisions, Overall Survival being the hardest problem to solve with accuracies ranging from 57%-71%, and GBM differentiation the one with the highest accuracy ranging from 80%-97%.

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<![CDATA[External Validation of Ultrasound Radiomics for Small (≤ 4 cm) Renal Mass Differentiation: A Comparison with Radiologists]]>https://eurekaselect.com/article/1363872024-03-28Background: Renal cell carcinoma, especially in small renal masses (≤ 4 cm) (SRM), has increased. Pathological analysis revealed a high proportion of benign masses, highlighting the urgent need for precise SRM differentiation.

Objectives: This research aimed to independently validate the performance of machine learning-based ultrasound (US) radiomics analysis in differentiating benign from malignant SRM, and to compare its performance with that of radiologists.

Methods: A total of 499 patients from two hospitals were retrospectively included in this study and divided into two cohorts. US images were used to extract radiomics features. To obtain the most robust features, inter-observer correlation coefficient, Spearman correlation coefficient, and least absolute shrinkage and selection operator methods were applied for feature selection. Three models were developed in the training data using the stochastic gradient boosting algorithm, including a clinical model, a radiomics model, and a combined model that integrated clinical factors and radiomics features. The performance of these models was evaluated in the independent external validation data, including discrimination, calibration, and clinical usefulness, and compared with pooled radiologists' assessments.

Results: The AUCs of the clinical, radiomics, and combined models were 0.844, 0.942, and 0.954, respectively. The radiomics and combined models significantly outperformed the clinical model (all p < 0.05), while no significant difference was observed between them (p = 0.32). The radiomics and combined models showed good discrimination and calibration. Decision curve analysis exhibited that the combined model had clinical usefulness. Compared with the pooled radiologists’ assessment (AUC, 0.799), the combined model showed superior classification results (p < 0.01) and higher specificity (p < 0.01) with similar sensitivity (p = 0.62).

Conclusion: The combined model incorporating clinical factors and radiomics features accurately distinguished benign from malignant SRM.

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<![CDATA[Motion-resolved 3D Pulmonary MRI Reconstruction using Sinusoidal Representation Networks]]>https://eurekaselect.com/article/1375382024-03-28Background: Deep learning reconstruction for free-breathing pulmonary MRI.

Objective: To propose a motion-resolved 3D pulmonary MRI reconstruction scheme using the sinusoidal representation network (SIREN).

Methods: The proposed scheme learns the registration maps using SIREN to register an averaging image to get the final reconstructions. The learning of the network relies only on the undersampled data from the specific subject. The usage of the network for outputting the registration maps enables a memory-efficient algorithm, as outputting registration maps instead of images only requires small networks. The training of the network based on only undersampled data enables an unsupervised learning scheme, which makes the proposed scheme useful in cases in which fully sampled data is not available.

Results: We compare the proposed SIREN-based motion-resolved reconstruction with two state-of-the-art methods for ten datasets. Both visual and quantitative comparison indicates the better performance of the proposed method.

Conclusion: In conclusion, the use of SIREN for 3D pulmonary MRI reconstruction allows for the efficient and accurate reconstruction of data that has been undersampled.

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<![CDATA[Automated Diagnosis of Bone Metastasis by Classifying Bone Scintigrams Using a Self-defined Deep Learning Model]]>https://eurekaselect.com/article/1375372024-03-28Background: Patients with cancer can develop bone metastasis when a solid tumor invades the bone, which is the third most commonly affected site by metastatic cancer, after the lung and liver. The early detection of bone metastases is crucial for making appropriate treatment decisions and increasing survival rates. Deep learning, a mainstream branch of machine learning, has rapidly become an effective approach to analyzing medical images.

Objective: To automatically diagnose bone metastasis with bone scintigraphy, in this work, we proposed to cast the bone metastasis diagnosis problem into automated image classification by developing a deep learning-based automated classification model.

Methods: A self-defined convolutional neural network consisting of a feature extraction sub-network and feature classification sub-network was proposed to automatically detect lung cancer bone metastasis, with a feature extraction sub-network extracting hierarchal features from SPECT bone scintigrams and feature classification sub-network classifying high-level features into two categories (i.e., images with metastasis and without metastasis).

Results: Using clinical data of SPECT bone scintigrams, the proposed model was evaluated to examine its detection accuracy. The best performance was achieved if the two images (i.e., anterior and posterior scans) acquired from each patient were fused using pixel-wise addition operation on the bladder-excluded images, obtaining the best scores of 0.8038, 0.8051, 0.8039, 0.8039, 0.8036, and 0.8489 for accuracy, precision, recall, specificity, F-1 score, and AUC value, respectively.

Conclusion: The proposed two-class classification network can predict whether an image contains lung cancer bone metastasis with the best performance as compared to existing classical deep learning models. The high accumulation of 99mTc MDP in the urinary bladder has a negative impact on automated diagnosis of bone metastasis. It is recommended to remove the urinary bladder before automated analysis.

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<![CDATA[Functional Integration of the Subregions of the Primary Motor Cortex: The Impact of Handedness and Hemispheric Lateralization]]>https://eurekaselect.com/article/1379322024-03-28Objective: Cytoarchitectonic mapping has revealed distinct subregions within Broadmann area 4 (BA 4) – BA 4a and BA 4p – with varying functional roles across tasks. We investigate their functional connectivity using resting-state functional magnetic resonance imaging (rsfMRI) to explore bilateral differences and the impact of handedness on connectivity within major brain networks.

Methods: This retrospective study involved 54 left- and right-handed subjects. We employed regions-to-regions-network rsfMRI analysis to examine the Cytoarchitectonic mapping of BA 4a and BA 4p functional connectivity with eight major brain networks.

Results: Our findings reveal differential connectivity patterns in both right-handed and left-handed subjects:

Both right-handed subjects' BA 4a and BA 4p subregions exhibit connections to sensorimotor, dorsal attention, frontoparietal, and anterior cerebellar networks. Notably, BA 4a shows unique connectivity to the posterior cerebellum, lateral visual networks, and select salience regions. Similar connectivity patterns are observed in left-handed subjects, with BA 4a linked to sensorimotor, dorsal attention, frontoparietal, and anterior cerebellar networks. However, BA 4a in left-handed subjects shows distinct connectivity only to the posterior cerebellum. In both groups, the right portion of BA 4 demonstrates heightened connectivity compared to the left portion within each subregion.

Conclusion: Our study uncovers complex patterns of functional connectivity within BA 4a and BA 4p, influenced by handedness. These findings emphasize the importance of considering hemisphere-specific and handedness-related factors in functional connectivity analyses, with potential implications for understanding brain organization in health and neurodegenerative diseases.

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<![CDATA[Correlation and Performance of three Ultrasound Techniques to Stage Hepatic Steatosis in Nonalcoholic Fatty Liver Disease]]>https://eurekaselect.com/article/1379332024-03-28Aims: There is a need to assess the severity of steatosis caused by Nonalcoholic Fatty Liver Disease (NAFLD). We explored new techniques in which Ultrasound-Guided Attenuation Parameter (UGAP), Liver Steatosis Analysis (LiSA) and Hepatorenal Index (HRI) can be applied to the grading of steatosis.

Materials and Methods: We enrolled 120 patients with or without NAFLD in this study who underwent UGAP, LiSA, HRI and controlled attenuation parameter (CAP) measurements in our hospital from September 2022 to April 2023. Spearman correlation coefficient was used to calculate the correlation between UGAP, LiSA, HRI and CAP values, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic accuracy of UGAP, LiSA, and HRI for different grades of steatosis.

Results: The cohort was classified into four groups based on means of CAP: S0 (no steatosis): 30/120, S1 (mild): 30/120, S2 (moderate): 15/120, and S3 (severe): 45/120. The cut-off values and areas under the receiver operating characteristic curve (AUC) of UGAP, LiSA and HRI for predicting different grades of steatosis were: S≥S1:227dB/m (AUC=0.904), 241dB/m (AUC=0.873), 1.19 (AUC=0.696); S≥S2:251dB/m (AUC=0.978), 264dB/m (AUC=0.913), 1.37 (AUC=0.770); S=S3:263dB/m (AUC=0.962), 289dB/m (AUC=0.923), 1.45 (AUC=0.809). The diagnostic efficacy of UGAP and LiSA was significantly better than HRI, and there were statistically significant differences (all p<0.05). A strong correlation was found between UGAP, LiSA and CAP values (UGAP: r=0.865; LiSA: r=0.810), moderate correlation between HRI and CAP values (r=0.476).

Conclusion: Both UGAP and LiSA have a strong correlation with CAP and are more accurate than HRI in diagnosing different grades of hepatic steatosis, which can be widely used in the diagnosis of liver steatosis.

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<![CDATA[Quantitative Perfusion Analysis of Contrast-enhanced Ultrasound Might Help Differentiate Benign and Malignant Solid Cystic Lesions of the Kidney: A Case Report and Literature Review]]>https://eurekaselect.com/article/1381522024-03-28Background: Mixed epithelial and stromal tumor of the kidney (MESTK) is a rare benign lesion that appears as a solid cystic renal lesion or complex renal cystic lesion on medical imaging. There are no definite imaging criteria for METSK diagnosis.

Case Presentation: We present a case of a solid cystic renal mass that was evaluated by contrast-enhanced ultrasound (CEUS) during an imaging workup. The patient underwent nephrectomy and histopathological confirmation of MESTK. The lesions showed hypoenhancement during the process. Quantitative perfusion analysis showed the septation of the solid cystic lesion to have lower peak enhancement with a longer rise time compared to the normal renal cortex.

Discussion: CEUS can visualize the microcirculation of the organ and reconstruction of the vessels. By providing a more detailed visualization of the microvessel, CEUS is a useful tool for further characterizing renal lesions that show indeterminate enhancement on CT. This study determined the time to peak to be shorter for the cancerous lesion than the normal renal cortex, while peak intensity did not differ between the cancerous lesion and the normal renal cortex.

Conclusion: Quantitative perfusion analysis of CEUS may be useful for differentiating benign and malignant solid cystic renal masses. Further investigation is needed to determine whether peak intensity is a useful parameter in differentiating benign and malignant solid cystic lesions of the kidney.

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<![CDATA[Magnetic Resonance Imaging of Dural Sinus Malformation in a Fetus: A Case Report]]>https://eurekaselect.com/article/1381512024-03-28Background: Dural sinus malformation (DSM) is a rather rare congenital condition that can be encountered in the fetus and infants. The cause and etiology of DSM remain unclear. Obstetric ultrasound plays a key role in screening fetal brain malformations, and MRI is frequently used as a complementary method to confirm the diagnosis and provide more details.

Objective: Here, we present a fetus with DSM by multiple imaging methods to help better understand the imaging characteristics of this malformation.

Case Presentation: A 22-year-old primipara was referred to our hospital at 25 weeks of gestation following the detection of a fetal intracranial mass without any symptoms. A prenatal ultrasound performed in our hospital at 25 + 2 gestational weeks showed a large anechoic mass with liquid dark space, while no blood flow was detected. After the initial evaluation, this primipara received a prenatal MRI in our hospital. This examination at 25 + 5 gestational weeks delineated a fan-shaped mass in the torcular herophili, which was iso-to hyperintense on T1WI and hypointense on T2WI. At the lower part of this lesion, a quasi-circular hyperintense on T1WI and a signal slightly hyperintense on T2WI could be seen. Meanwhile, the adjacent brain parenchyma was compressed by the mass.

Conclusion: We reviewed the current literature to obtain a better understanding of the mechanisms, imaging characteristics, and survival status of DSM. Although the primipara of the present study regretfully opted for elective termination of pregnancy, the reevaluation of DSM survival deserves more attention because of the better survival data from recent studies.

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<![CDATA[nnUNet for Automatic Kidney and Cyst Segmentation in Autosomal Dominant Polycystic Kidney Disease]]>https://eurekaselect.com/article/1381502024-03-28Background: Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a genetic disorder that causes uncontrolled kidney cyst growth, leading to kidney volume enlargement and renal function loss over time. Total kidney volume (TKV) and cyst burdens have been used as prognostic imaging biomarkers for ADPKD.

Objective: This study aimed to evaluate nnUNet for automatic kidney and cyst segmentation in T2-weighted (T2W) MRI images of ADPKD patients.

Methods: 756 kidney images were retrieved from 95 patients in the Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP) cohort (95 patients × 2 kidneys × 4 follow-up scans). The nnUNet model was trained, validated, and tested on 604, 76, and 76 images, respectively. In contrast, all images of each patient were exclusively assigned to either the training, validation, or test sets to minimize evaluation bias. The kidney and cyst regions defined using a semi-automatic method were employed as ground truth. The model performance was assessed using the Dice Similarity Coefficient (DSC), the intersection over union (IoU) score, and the Hausdorff distance (HD).

Results: The test DSC values were 0.96±0.01 (mean±SD) and 0.90±0.05 for kidney and cysts, respectively. Similarly, the IoU scores were 0.91± 0.09 and 0.81±0.06, and the HD values were 12.49±8.71 mm and 12.04±10.41 mm, respectively, for kidney and cyst segmentation.

Conclusion: The nnUNet model is a reliable tool to automatically determine kidney and cyst volumes in T2W MRI images for ADPKD prognosis and therapy monitoring.

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<![CDATA[Enhanced CT Findings in a Case of Recurrent Pelvic Follicular Dendritic Cell Sarcoma]]>https://eurekaselect.com/article/1381542024-03-28Introduction: Follicular Dendritic Cell Sarcomas (FDCS)was first found in 1986; the specificity of the disease is its rarity, with an incidence of only 0.4%, numerous doctors for its lack of understanding, the accuracy of imaging diagnosis is not great, which is easy to delay the treatment. This article summarizes several characteristic imaging manifestations of FDCS to provide imaging physicians with an understanding of the imaging properties of this rare disease. When faced with complex cases, the radiologist can consider this disease and include it in the differential diagnosis. FDCS occurs mainly in lymph nodes, mainly in the head and neck. The main symptoms are fatigue, local pain, or painless mass. The treatment method is not uniform, but scholars agree that we should strive for the opportunity of surgery as much as possible.

Case Presentation: This paper reported a case of FDCS with pelvic recurrence 3 years after surgery. The patient was suspected to have lymphoma by postoperative pathology in the local hospital, and it is recommended that the patient be reexamined regularly. A soft tissue mass was recently found again in the left pelvic cavity. After an enhanced CT examination, the radiologist was skeptical of the previous diagnosis of lymphoma. Subsequently, a needle biopsy was performed at Peking University Shougang Hospital. The pathological results rejected the prior diagnosis of lymphoma after consultation with additional hospitals, and the patient was diagnosed with FDCS.

Conclusions: The imaging manifestations of FDCS lack absolute specificity, but it also has imaging characteristics, such as large areas of necrosis in the huge mass, rough mass calcification in the mass, enhanced scan showed “fast in and slow out” mode, and there were blood vessels in the tumor. FDCS mainly occurs in lymph nodes and is easily misdiagnosed as GIST, inflammatory myoblastoma, lymphoma, etc. Radiologists should continue to collect cases of this disease and include suspected cases in the differential diagnosis in clinical work.

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<![CDATA[Imaging Characteristics of Clear Cell Papillary Renal Cell Carcinoma: Identifying the Sheep in Wolf’s Clothing]]>https://eurekaselect.com/article/1381492024-03-28Objective: This study aimed to describe the characteristics of computed tomography (CT) and magnetic resonance imaging (MRI) of clear cell papillary renal cell carcinoma (CCPRCC).

Methods: This retrospective study comprised 27 patients diagnosed with 29 tumors of CCPRCC. The study was approved by the Medical Ethics Committee and the requirement for the informed consent was waived. The inclusion criteria stipulated pathology-confirmed CCPRCCs with at least one preoperative imaging examination, including CT or MRI. Two experienced radiologists independently analyzed the imaging characteristics, including size, location, growth mode, morphology, texture, density, and enhancement pattern. Paired t-test was used to compare differences in CT Hounsfield unit values and apparent diffusion coefficient (ADC) imaging between the tumor and the renal cortex.

Results: The mean age of the 27 patients was 57.0 ± 14.2 years. Nineteen patients underwent CT, while 12 underwent MRI (There are 4 patients underwent not only CT but also MRI). Among the cases, 26 (96%) were single, and 1 (4%) was multiple, consisting of three lesions. Out of the 29 tumors, 15 (52%) were located in the left kidney and 14 (48%) in the right kidney. The mean tumor diameter was 3.3 ± 1.7 cm. Furthermore, 19 (66%), 3 (10%), and 7 (24%) tumors were solid, cystic, mixed solid, and cystic type, respectively. The growth mode was endogenous and exogenous in 8 (28%) and 21 (72%) tumors, respectively. The tumor shape was irregular and round in 5 (17%) and 24 (83%) tumors, respectively. The CT value of the tumor was approximately 33.2 ± 9.8 HU, which was not significantly different from that of the renal cortex(31.1 ± 6.3HU)(p = 0.343). Furthermore, 7 (24%), 12 (41%), and 3 (10%) had calcification, cystic degeneration, and hemorrhage, respectively. In 12 tumors, hypointense and hyperintense were predominant on T1 and T2-weighted images, respectively. The tumor capsule was found at the edge of 12 tumors. The average ADC value of the tumor (1.54 ± 0.74 × 10−3 mm2/s) and that of the renal cortex(1.68 ± 0.63×10–3mm2 /s) was not statistically significantly different (p = 0.260). The enhancement scanning revealed “wash-in and wash-out” enhancement in 19 (68%) tumors, continuous or progressive enhancement in 6 (21%) tumors, and enhanced cystic wall and central separation in 3 (11%) tumors.

Conclusion: CCPRCC occurs more likely in middle-aged and elderly individuals, and the tumor is prone to cystic degeneration, with rare bleeding and calcification, and no obvious limitation on MRI diffusion-weighted imaging, which enhancement form performs as mainly “wash-in and washout,” but the final diagnosis depends on histopathology.

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<![CDATA[A New Method Used to Enhance the SPAIR Image of the Spine MRI]]>https://eurekaselect.com/article/1382862024-03-28Background: Magnetic resonance imaging (MRI) is a handy diagnostic tool for orthopedic disorders, particularly spinal and joint diseases.

Methods: The lumbar intervertebral disc is visible in the T1 and T2 weight sequences of the spine MRI, which aids in diagnosing lumbar disc herniation, lumbar spine tuberculosis, lumbar spine tumors, and other conditions. The lumbar intervertebral disc cannot be seen accurately in the Spectral Attenuated Inversion Recovery (SPAIR) due to weaknesses in the fat and frequency offset parameters, which is not conducive to developing the intelligence diagnosis model of medical image.

Results: In order to solve this problem, we propose a composite framework, which is first to use the contrast limited adaptive histogram equalization (CLAHE) method to enhance the SPAIR image contrast of the spine MRI and then use the non-local means method to remove the noise of the image to ensure that the image contrast is uniform without losing details. We employ the Information Entropy (IE), Peak signal-to-noise ratio (PSNR), and feature similarity index measure (FSIM) to quantify image quality after enhancement by the composite framework.

Conclusion: The outcomes of the experiments’ output images and quantitative data indicate that our composite framework is better than others.

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<![CDATA[Study on Improved Computed Tomography Scanning Parameters for Patients with Nasal Bone Fracture Based on ITK Three-dimensional Labelling]]>https://eurekaselect.com/article/1383942024-03-28Objective: To investigate the influence of improved exposure parameters on the image quality of multi-slice spiral computed tomography in nasal bone fracture imaging.

Methods: Fifty patients with optimised parameters combined with coronal scanning were allocated to the modified group and 50 patients with routine scanning parameters to the routine group. The image quality and nasal bone display of the two groups were assessed and statistically analysed, and the quality of scanned images before and after parameter optimisation was compared.

Results: The optimised image quality was better than that of conventional scanning parameters. The parameters used were 120 kv, 180 mA, a layer thickness of 0.625 mm, a layer spacing of 0.312 mm, a pitch of 0.516:1, a frame speed of 1 s, a scanning field of 12 cm and a reconstructed layer thickness for scanning of 0.625 mm; the scanned image was clear, and the parameter optimisation was achieved. This ensures that the annotation data in ITK labelling is more accurate.

Conclusion: The optimised parameters and scanned coronal plane show the nasal bone and its surrounding structures more comprehensively, which is of high diagnostic value for nasal bone fractures. The three-dimensional annotation data based on ITK is more standardised, laying a foundation for the subsequent research of artificial intelligence modelling.

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<![CDATA[A Systematic Review and Meta-Analysis of MRI Radiomics for Predicting Microvascular Invasion in Patients with Hepatocellular Carcinoma]]>https://eurekaselect.com/article/1384612024-03-28Background: The prediction power of MRI radiomics for microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) remains uncertain.

Objective: To investigate the prediction performance of MRI radiomics for MVI in HCC.

Methods: Original studies focusing on preoperative prediction performance of MRI radiomics for MVI in HCC, were systematically searched from databases of PubMed, Embase, Web of Science and Cochrane Library. Radiomics quality score (RQS) and risk of bias of involved studies were evaluated. Meta-analysis was carried out to demonstrate the value of MRI radiomics for MVI prediction in HCC. Influencing factors of the prediction performance of MRI radiomics were identified by subgroup analyses.

Results: 13 studies classified as type 2a or above according to the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis statement were eligible for this systematic review and meta-analysis. The studies achieved an average RQS of 14 (ranging from 11 to 17), accounting for 38.9% of the total points. MRI radiomics achieved a pooled sensitivity of 0.82 (95%CI: 0.78 – 0.86), specificity of 0.79 (95%CI: 0.76 – 0.83) and area under the summary receiver operator characteristic curve (AUC) of 0.88 (95%CI: 0.84 – 0.91) to predict MVI in HCC. Radiomics models combined with clinical features achieved superior performances compared to models without the combination (AUC: 0.90 vs 0.85, P < 0.05).

Conclusion: MRI radiomics has the potential for preoperative prediction of MVI in HCC. Further studies with high methodological quality should be designed to improve the reliability and reproducibility of the radiomics models for clinical application.

The systematic review and meta-analysis was registered prospectively in the International Prospective Register of Systematic Reviews (No. CRD42022333822).

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<![CDATA[7 Tesla MRI Liver Fat Quantification in Mice: Data Quality Assessment]]>https://eurekaselect.com/article/1384632024-03-28Purpose: The objective of this study was to evaluate the robustness of proton density fat fraction (PDFF) data determined by magnetic resonance imaging (MRI) and spectroscopy (MRS) via spatially resolved error estimation.

Materials and Methods: Using standard T2* relaxation time measurement protocols, in-vivo and ex-vivo MRI data with water and fat nominally in phase or out of phase relative to each other were acquired on a 7 T small animal scanner. Based on a total of 24 different echo times, PDFF maps were calculated in a magnitude-based approach. After identification of the decisive error-prone variables, pixel-wise error estimation was performed by simple propagation of uncertainty. The method was then used to evaluate PDFF data acquired for an explanted mouse liver and an in vivo mouse liver measurement.

Results: The determined error maps helped excluding measurement errors as cause of unexpected local PDFF variations in the explanted liver. For in vivo measurements, severe error maps gave rise to doubts in the acquired PDFF maps and triggered an in-depth analysis of possible causes, yielding abdominal movement or bladder filling as in vivo occurring reasons for the increased errors.

Conclusion: The combination of pixel-wise acquisition of PDFF data and the corresponding error maps allows for a more specific, spatially resolved evaluation of the PDFF value reliability.

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<![CDATA[Internal Carotid Artery Dissecting Aneurysm Associated with Persistent Trigeminal Artery: A Case Report]]>https://eurekaselect.com/article/1384622024-03-28Background: Persistent trigeminal artery (PTA) is the most common vascular anastomosis between the carotid artery and vertebrobasilar systems. We report a very rare case of dissecting aneurysm in the right internal carotid artery (ICA) with ipsilateral PTA and discuss its clinical importance.

Case Report: A 38-year-old male presented to the emergency department with paroxysmal dysphasia for 6h. Brain magnetic resonance (MR) imaging showed acute cerebral infarction of the right corona radiata and right parietal lobe. Three-dimensional time-of-flight MR angiography (3D TOF MRA) revealed severe stenosis of the petrous segment (C1 portion) of the right internal carotid artery and a PTA originating from the right ICA cavernous segment (C4 portion), with a length of approximately 1.8cm and a diameter of approximately 0.2cm. The ICA segments are all named according to the Bouthilier classification. The basilar artery (BA) under union was well developed. The bilateral posterior communicating arteries were also present. One day later, the high-resolution vessel-wall MR demonstrated a dissecting aneurysm in the C1 portion of the right ICA. The length of the dissecting aneurysm is approximately 4.4cm, the diameter of the true lumen at the most severe stenosis is approximately 0.2cm, and the diameter of the false lumen is approximately 0.8cm. Subsequent digital subtraction angiography (DSA) confirmed a dissecting aneurysm in the C1 portion of the right ICA. The patient was treated conservatively and did not undergo interventional surgery. Four months later, head and neck MRA showed that the right ICA blood flow was smooth and that the dissecting aneurysm had disappeared.

The Ethics Committee of Liaocheng People’s Hospital approved the research protocol in compliance with the Helsinki Declaration. Written informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article.

Conclusion: Flow alteration with PTA may have influenced the formation of ICA dissection in this patient. Awareness of this is crucial in clinical practice because it can influence treatment options and intervention procedures.

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<![CDATA[Machine Learning-based Deep Analysis of Human Blood using NIR Spectrophotometry Signatures]]>https://eurekaselect.com/article/1384652024-03-28Background: Non-invasive bio-diagnostics are essential for providing patients with safer treatment. In this subject, significant growth is attained for noninvasive anaemia detection in terms of Hb concentration by means of spectroscopic and image analysis. The lower satisfaction rate is found due to inconsistent results in various patient settings.

Objective: This observational study aims to present an adaptable point-of-care Near-Infrared (NIR) spectrophotometric approach with a constructive Machine Learning (ML) algorithm for monitoring Haemoglobin (Hb) concentration by considering dominating influencing factors into account.

Methods: To accomplish this objective, 121 subjects (19.2-55.4 years) were enrolled in the study, having a wide range of Hb concentrations (8.2-17.4 g/dL) obtained from two standard Laboratory analyzers. To inspect the performance, the unique dimensionality reduction approaches are applied with numerous regression models using 5-fold cross-validation.

Results: The optimum accuracy is found using support vector regression (SVR) and mutual information having 3 independent features i.e. Pearson correlation (r)= 0.79, standard deviation (SD)= 1.07 g/dL, bias=-0.13 g/dL and limits of agreement (LoA)=-2.22 to 1.97 g/dL. Additionally, comparability between two standard laboratory analyzers is found as; r=0.97, SD=0.50 g/dL, bias=0.21 g/dL, and LoA= -0.77 to 1.19 g/dL.

Conclusion: The precision of ±1 g/dL in 5-fold cross-validation ensures the same performance irrespective of different age groups, gender, BMI, smoking level, drinking level, and skin type. The outcomes with the offered NIR sensing system and an exclusive ML algorithm can accelerate its’ requirement at remote locative rural areas and critical care units where continuous Hb monitoring is compulsory.

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<![CDATA[Conspicuous Peripheral Retinal Hemorrhages with a Relatively Preserved Posterior Pole in Immune Thrombocytopenic Purpura]]>https://eurekaselect.com/article/1384642024-03-28Background: Immune thrombocytopenic purpura (ITP) is a rare auto-antibody mediated disease of isolated thrombocytopenia (<100,000/μL) with normal haemoglobin levels and leukocyte counts. Only a small number of ITP cases have been reported with accompanying ophthalmological findings. Herein, we report an ITP case with demonstrative retinal haemorrhages.

Case Presentation: A fifty-five-year-old woman with a known history of type 2 diabetes mellitus was referred to our clinic with blurred vision. After detailed anamnesis and clinical assessment, she was diagnosed as primary ITP in haematology department, and systemic steroid (1.5mg/kg) therapy was initiated. During her follow-up, a concomitant peripheral facial paralysis (PFP) emerged. In the course of follow-up, her platelet counts increased gradually, the retinal haemorrhages regressed partially, and the PFP recovered completely.

Conclusion: ITP is a rare haematologic disease that sometimes manifests with additional systemic involvements, and this disease should be remembered in the differential diagnosis of unusual retinal haemorrhages, which might be the only presenting feature.

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<![CDATA[Primary Pulmonary Enteric Adenocarcinoma: Rare Imaging Findings]]>https://eurekaselect.com/article/1384672024-03-28 Introduction: Pulmonary enteric adenocarcinoma (PEAC) is an extremely rare variant of lung adenocarcinoma characterized by pathological features similar to those of colorectal adenocarcinoma. It is mostly observed on computed tomography (CT) and positron emission tomography (PET)/CT as solitary or multiple nodules/masses in the lung. It tends to grow rapidly and is difficult to distinguish from lung metastatic colorectal cancer. Herein, we have presented a case of PEAC with special imaging findings.

Case Presentation: A chest CT scan of a 72-year-old man with suspected chronic pneumonia revealed a well-defined consolidation in the upper lobe of the left lung. The lesion was slightly enlarged at the 9-month follow-up, and low FDG accumulation was subsequently observed using 18F-fluorodeoxyglucose (18F-FDG) PET/CT scans. The patient was later diagnosed with PEAC through percutaneous lung biopsy.

Conclusion: Our case has demonstrated specific imaging findings of PEAC.

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<![CDATA[Prediction of Microwave Ablation Recurrence in Pulmonary Malignancies Using Preoperative Computed Tomography Radiomics Models]]>https://eurekaselect.com/article/1384682024-03-28Background: Assessing the early efficacy of microwave ablation (MWA) for pulmonary malignancies is a challenge for interventionalists. However, performing an accurate efficacy assessment at an earlier stage can significantly enhance clinical intervention and improve the patient’s prognosis.

Purpose: This research aimed to create and assess non-invasive diagnostic techniques using pre-operative computed tomography (CT) radiomics models to predict the recurrence of MWA in pulmonary malignancies.

Materials and Methods: We retrospectively enrolled 116 eligible patients with pulmonary malignancies treated with MWA. we separated the patients into two groups: a recurrence group (n = 28) and a non-recurrence group (n = 88), following the modified Response Evaluation Criteria in Solid Tumors (m-RECIST) criteria. We segmented the preoperative tumor area manually. We expanded outward the tumor boundary 4 times, with a width of 3 mm, using the tumor boundary as the baseline. Five groups of radiomics features were extracted and screened using max-relevance and min-redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) regression. Weight coefficients of the aforementioned features were used to calculate the Radscore and construct radiomics models for both tumoral and peritumoral areas. The Radscore from the radiomics model was combined with clinical risk factors to construct a combined model. The performance and clinical usefulness of the combined models were assessed through the evaluation of receiver operating characteristic (ROC) curves, the Delong test, calibration curves, and decision curve analysis (DCA) curves.

Results: The clinical risk factor for recurrence after MWA was tumor diameter (P < 0.05). Both tumoral and four peritumoral radiomics models exhibited high diagnostic efficacy. Furthermore, the combined 1 (C1)-RO model and the combined 2 (C2)-RO model showed higher efficacy with area under the curve (AUCs) of 0.89 and 0.89 in the training cohort, and 0.93 and 0.94 in the validation cohort, respectively. Both combined models demonstrated excellent predictive accuracy and clinical benefit.

Conclusion: Preoperative CT radiomics models for both tumoral and peritumoral regions are capable of accurately predicting the recurrence of pulmonary malignancies after MWA. The combination of both models may lead to better performance and may aid in devising more effective preoperative treatment strategies.

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<![CDATA[The Sentinel Node and Occult Lesion Localization (SNOLL) Technique Using a Single Radiopharmaceutical in Non-palpable Breast Lesions]]>https://eurekaselect.com/article/1380182024-03-28Background: In order to perform a full surgical resection on non-palpable breast lesions, a current method necessitates correct intraoperative localization. Additionally, because it is an important prognostic factor for these patients, the examination of the lymph node status is crucial.

Objective: The aim of this study was to evaluate the efficiency of the sentinel node and occult lesion localization (SNOLL) technique in localizing nonpalpable breast lesions together with sentinel lymph node (SLN) using a single radiotracer, that is, nanocolloid particles of human serum albumin (NC) labeled with technetium-99m (99mTc).

Methods: 39 patients were included, each having a single non-palpable breast lesion and clinically no evidence of axillary disease. Patients received 99mTc- NC intratumorally on the same day as surgery under the guidance of ultrasound. Planar and single-photon emission computed tomography/computed tomography lymphoscintigraphy were performed to localize the breast lesion and the SLN. The occult breast lesion and SLN were both localized using a hand-held gamma-probe, which was also utilized to determine the optimal access pathway for surgery. In order to ensure a radical treatment in a single surgical session and reduce the amount of normal tissue that would need to be removed, the surgical field was checked with the gamma probe after the specimen was removed to confirm the lack of residual sources of considerable radioactivity.

Results: Breast lesions were successfully localized and removed in all patients. Pathological findings revealed breast carcinoma in 11/39 patients (28%) and benign lesions in 28 (72%). Axillary SLNs were detected in 31/39 (79.5%) patients. The metastatic involvement of SLN was only seen in two cases.

Conclusion: While the identification rate of the SNOLL technique performed with an intratumoral injection of 99mTc-NC as the sole radiotracer in non-palpable breast lesions was great, it was not fully satisfactory in SLNs.

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<![CDATA[Clinical Implementation of Dual-Energy CT Technical for Hepatobiliary Imaging]]>https://eurekaselect.com/article/1369972024-03-28 <![CDATA[A Good Prognosis of Patients with Acute Pancreatitis Combined with Pulmonary Embolism: Early Identification and Intervention]]>https://eurekaselect.com/article/1384602024-03-28Background: Pulmonary embolism (PE) is a relatively rare vascular complication of acute pancreatitis (AP), and its mortality rate is high. To our knowledge, relevant literature reports still need to be summarized. In this study, we analyzed the clinical characteristics, treatment, and prognosis of five patients with AP complicated by PE and summarized and reviewed the relevant literature.

Methods: Clinical data of patients with AP complicated by PE treated in Taizhou Hospital of Zhejiang Province between January 2017 and September 2022 were retrospectively collected. Combined with the relevant literature, the clinical characteristics, treatment, and prognoses of patients with AP combined with PE were analyzed and summarized.

Results: Five patients were eventually enrolled in this study. Among the five patients with AP complicated by PE, all (100%) had symptoms of malaise, primarily chest tightness, shortness of breath, and dyspnea. All patients (100%) had varied degrees of elevated D-dimer levels and a significant decrease in the pressure of partial oxygen (PO2) and pressure of arterial oxygen to fractional inspired oxygen concentration ratio (PaO2/FiO2). Computed tomographic angiography (CTA) or pulmonary ventilation/perfusion imaging revealed a pulmonary artery filling defect in these patients. One patient (20%) had left calf muscular venous thrombosis before the occurrence of PE. Four patients (80%) were treated with lowmolecular- weight heparin (LMWH), and one patient (20%) was treated with rivaroxaban during hospitalization; all continued oral anticoagulant therapy after discharge. All patients (100%) were cured and discharged. No patients showed recurrence of AP or PE.

Conclusion: PE is a rare but life-threatening complication of AP. However, once diagnosed, early treatment with anticoagulation or radiological interventional procedures is effective, and the prognosis is good.

Core Tips: Pulmonary embolism (PE) is a rare but life-threatening complication of acute pancreatitis (AP). Its early diagnosis and timely anticoagulation or radiological intervention can reduce mortality. However, only nine cases have been reported in the English literature thus far, and they are all case reports. Our study is the first systematic analysis of patients with AP combined with PE with a review of the relevant literature. Our patients and those reported in the literature were discharged with good prognoses under treatment such as anticoagulation and vascular intervention. These cases remind clinicians that, in patients with AP, especially those with risk factors for venous thrombosis, it is necessary to monitor the D-dimer level dynamically. Clinicians should pay attention to AP patients' symptoms and related examinations to reduce the chance of a missed diagnosis or misdiagnosis of PE.

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<![CDATA[Iatrogenic Pseudoaneurysm with Acute Arterial Thrombosis in Multiple Branches of the Lower Limbs Treated by Ultrasound-guided Thrombin Injection: A Case Report]]>https://eurekaselect.com/article/1384662024-03-28Abstract: Introduction: With the development of vascular intervention, pseudoaneurysm complications are increasing. Ultrasound-guided thrombin injection (UGTI) is currently the treatment of choice for pseudoaneurysm, but the pharmacological properties of thrombin may trigger acute thrombosis within the vessel lumen. Despite a very low incidence, this type of primary arterial thrombosis is a serious complication of UGTI, and cases involving multiple branches of the lower limb arteries are particularly rare.

Case Presentation: Here, we report a case of a 65-year-old male who underwent UGTI for the treatment of an iatrogenic pseudoaneurysm of the femoral artery complicated by acute thrombosis of multiple arteries in the lower limbs, and the patient ultimately underwent a successful thrombectomy.

Conclusion: We reviewed the case and analyzed the possible etiologic causes, providing a reference for future clinical work.

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<![CDATA[Intravoxel Incoherent Motion Diffusion-weighted Magnetic Resonance Imaging combined with Texture Analysis in Predicting the Histological Grades of Rectal Adenocarcinoma]]>https://eurekaselect.com/article/1385412024-03-28Purpose: To evaluate the predictive value of 3.0T MRI Intravoxel Incoherent motion diffusion-weighted magnetic resonance imaging (IVIM-DWI) combined with texture analysis (TA) in the histological grade of rectal adenocarcinoma.

Methods: Seventy-one patients with rectal adenocarcinoma confirmed by pathology after surgical resection were collected retrospectively. According to pathology, they were divided into a poorly differentiated group (n=23) and a moderately differentiated group (n=48). The IVIM-DWI parameters and TA characteristics of the two groups were compared, and a prediction model was constructed by multivariate logistic regression analysis. ROC curves were plotted for each individual and combined parameter.

Results: There were statistically significant differences in D and D* values between the two groups (P < 0.05). The three texture parameters SmallAreaEmphasis, Median, and Maximum had statistically significant differences between groups (P = 0.01, 0.004, 0.009, respectively). The logistic regression prediction model showed that D*, the median, and the maximum value were significant independent predictors, and the AUC of the regression prediction model was 0.860, which was significantly higher than other single parameters.

Conclusion: 3.0T MRI IVIM-DWI parameters combined with TA can provide valuable information for predicting the histological grades of rectal adenocarcinoma one week before the operation.

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<![CDATA[Computational Model for the Detection of Diabetic Retinopathy in 2-D Color Fundus Retina Scan]]>https://eurekaselect.com/article/1383752024-03-28Background: Diabetic Retinopathy (DR) is a growing problem in Asian countries. DR accounts for 5% to 7% of all blindness in the entire area. In India, the record of DR-affected patients will reach around 79.4 million by 2030.

Aims: The main objective of the investigation is to utilize 2-D colored fundus retina scans to determine if an individual possesses DR or not. In this regard, Engineering-based techniques such as deep learning and neural networks play a methodical role in fighting against this fatal disease.

Methods: In this research work, a Computational Model for detecting DR using Convolutional Neural Network (DRCNN) is proposed. This method contrasts the fundus retina scans of the DR-afflicted eye with the usual human eyes. Using CNN and layers like Conv2D, Pooling, Dense, Flatten, and Dropout, the model aids in comprehending the scan's curve and color-based features. For training and error reduction, the Visual Geometry Group (VGG-16) model and Adaptive Moment Estimation Optimizer are utilized.

Results: The variations in a dataset like 50%, 60%, 70%, 80%, and 90% images are reserved for the training phase, and the rest images are reserved for the testing phase. In the proposed model, the VGG-16 model comprises 138M parameters. The accuracy is achieved maximum rate of 90% when the training dataset is reserved at 80%. The model was validated using other datasets.

Conclusion: The suggested contribution to research determines conclusively whether the provided OCT scan utilizes an effective method for detecting DRaffected individuals within just a few moments.

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<![CDATA[MRI Plain Scan: A Tool in the Management of Cervical Cancer during Pregnancy]]>https://eurekaselect.com/article/1383762024-03-28Objective: The purpose of this study was to assess the diagnostic value of magnetic resonance imaging (MRI) in staging and treatment of cervical cancer in pregnancy, and to evaluate the benefit of apparent diffusion coefficient (ADC) during neoadjuvant chemotherapy management.

Materials and Methods: This was a retrospective cohort study. Patients were divided into two groups according to the stage of cervical cancer. The mean term of pregnancy at the time of the diagnosis was the early second trimester (range 10-27 weeks) and the median age was 33 years (range 26-40 years). The abdominal and pelvic MRI images and clinical data of these patients were reviewed. Tumor size, local tumor spread, and nodal involvement were evaluated using an MRI dataset. The treatment and follow-up imaging were analyzed as well, and the ADC was measured before and after the chemotherapy.

Results: 16 patients with histopathologically confirmed cervical cancer during pregnancy were retrospectively enrolled. 7 patients were diagnosed with local cervical cancer (FIGO stage IAI) and designated as early stage group, as the lesion was invisible on MRI. In this group, pregnancies were allowed to continue until cesarean delivery (CD) at 38-41 weeks. The other 9 patients presenting with local or extensive cervical cancer (FIGO stage IB2-IIA2) were designated as the advanced-stage group. The lesion could be measured and analyzed on MRI. They were treated with neoadjuvant chemotherapy in pregnancy. Among them, 6 patients underwent TP regimen (paclitaxel 135~175 mg/m2 plus cisplatin 70~75 mg/m2), while 3 patients received TC regimen (paclitaxel 135~175 mg/m2 plus carboplatin AUC=5). NACT was performed for 1 to 2 courses before surgery. ADC demonstrated significant differences before and after chemotherapy administered during pregnancy (1.06 ± 0.12 sec/mm2 vs. 1.34 ± 0.21 sec/mm2).

Conclusion: MRI has been found to be helpful in staging cervical cancer in pregnancy. Patients with stage IA confirmed by MRI can choose conservative treatment and continue the pregnancy until term birth. MRI can dynamically monitor the efficacy of chemotherapy for patients with stage IB and above during pregnancy. ADC value can have a potential role in the evaluation of chemotherapy efficacy.

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<![CDATA[Immunoglobulin G4 (IgG4)-related Lymphadenopathy in Submandibular Space Mimicking Submandibular Malignant Tumor: A Case Report]]>https://eurekaselect.com/article/1383912024-03-28Background: Immunoglobulin G4 (Ig G4)-related disease is rare; however, it is a fibroinflammatory disease that has been studied a lot so far. Although the expression pattern varies depending on the organ affected, it usually manifests as organ hypertrophy and organ dysfunction.

Case Presentation: A 46-year-old man was referred to our otorhinolaryngology department for left submandibular swelling and tenderness that occurred 2 weeks ago. He was treated with antibiotics (augmentin 625mg, per oral) for 2 weeks, but his symptoms did not improve, and his white blood cell (WBC) count was 10,500 /μL (normal 3,800−10,000 /μL).

Conclusion: A mass-like lesion of the submandibular space has been concluded and the laboratory findings have been satisfactory (IgG4 level); IgG4-related disease, which is rare, but recently often reported, can be included in the differential diagnosis.

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<![CDATA[A Novel Approach to the Technique of Lung Region Segmentation Based on a Deep Learning Model to Diagnose COVID-19 X-ray Images]]>https://eurekaselect.com/article/1385422024-03-28Background: The novel coronavirus pandemic has caused a global health crisis, placing immense strain on healthcare systems worldwide. Chest X-ray technology has emerged as a critical tool for the diagnosis and treatment of COVID-19. However, the manual interpretation of chest X-ray films has proven to be inefficient and time-consuming, necessitating the development of an automated classification system.

Objective: In response to the challenges posed by the COVID-19 pandemic, we aimed to develop a deep learning model that accurately classifies chest X-ray images, specifically focusing on lung regions, to enhance the efficiency and accuracy of COVID-19 and pneumonia diagnosis.

Methods: We have proposed a novel deep network called “FocusNet” for precise segmentation of lung regions in chest radiographs. This segmentation allows for the accurate extraction of lung contours from chest X-ray images, which are then input into the classification network, ResNet18. By training the model on these segmented lung datasets, we sought to improve the accuracy of classification.

Results: The performance of our proposed system was evaluated on three types of lung regions in normal individuals, COVID-19 patients, and those with pneumonia. The average accuracy of the segmentation model (FocusNet) in segmenting lung regions was found to be above 90%. After reclassification of the segmented lung images, the specificities and sensitivities for normal, COVID-19, and pneumonia were excellent, with values of 98.00%, 99.00%, 99.50%, and 98.50%, 100.00%, and 99.00%, respectively. ResNet18 achieved impressive area under the curve (AUC) values of 0.99, 1.00, and 0.99 for classifying normal, COVID-19, and pneumonia, respectively, on the segmented lung datasets. Moreover, the AUC values of the three groups increased by 0.02, 0.02, and 0.06, respectively, when compared to the direct classification of unsegmented original images. Overall, the accuracy of lung region classification after processing the datasets was 99.3%.

Conclusion: Our deep learning-based automated chest X-ray classification system, incorporating lung region segmentation using FocusNet and subsequent classification with ResNet18, has significantly improved the accuracy of diagnosing respiratory lung diseases, including COVID-19. The proposed approach has great potential to revolutionize the diagnosis of COVID-19 and other respiratory lung diseases, offering a valuable tool to support healthcare professionals during health crises.

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<![CDATA[Differentiating the Presence of Brain Stroke Types in MR Images using CNN Architecture]]>https://eurekaselect.com/article/1384692024-03-28Backgroud: Stroke is reportedly the biggest cause of death and disability in the world, according to the World Health Organisation (WHO). The severity of a stroke can be lowered by recognising the many stroke warning indicators early on. Using CNN, the primary goal of this study is to predict the likelihood that a brain stroke would develop at an early stage.

Objective: The novelty of the proposed work is to acquire models that can accurately differentiate between stroke and no-stroke (normal) cases using MR Imaging sequences like DWI, SWI, GRE and T2 FLAIR aiding in timely diagnosis and treatment decisions.

Methods: A dataset comprising real time MRI scans of patients with stroke and no-stroke conditions was collected and preprocessed for model training. The preprocessing involves standardizing the resolution of the images, normalizing pixel values, and augmenting the dataset to enhance model generalization. The ResNet, DenseNet, EfficientNet, and VGG16 architectures were implemented and trained on the preprocessed dataset. The training process involved optimizing model parameters using stochastic gradient descent and minimizing the loss function.

Results: The results demonstrate promising performance across all models by obtaining an accuracy of 98% for ResNet, DenseNet and EfficientNet, while 97% for VGG16 in differentiating the stroke using real time MRI data.

Conclusion: The proposed work explored the effectiveness of CNN models, including ResNet, DenseNet, EfficientNet, and VGG16, for the differentiation of stroke and no-stroke cases. The models were trained and evaluated using a real-time dataset of brain MR Images. The obtained accuracies highlight the potential of CNN models in accurately differentiating between stroke and non-stroke cases.

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<![CDATA[The Diagnostic Value of Ultrasound-guided Attenuation Parameter (UGAP) in metabolic fatty liver disease]]>https://eurekaselect.com/article/1383772024-03-28Objectives: To evaluate the diagnostic value of ultrasound-guided attenuation parameter (UGAP) in metabolic fatty liver disease (MAFLD) and to explore the correlation between the attenuation coefficient (AC) value of UGAP and commonly used clinical obesity indicators.

Methods: A total of 121 subjects who had physical examinations from November 2021 to March 2022 were prospectively selected; the height, weight, and waist circumference (WC) of all subjects were collected, and conventional ultrasound and UGAP examinations for all subjects.

Results: Under the standard of conventional ultrasound, among the 121 subjects, 53 had normal liver, 42 had mild fatty liver, 21 had moderate fatty liver, and 5 had severe fatty liver. The mean AC value of 121 patients was 0.66 ± 0.13 dB/cm/MHz. The best cut-off values for diagnosing mild, moderate, and severe fatty liver were 0.65dB/cm/MHz, 0.72dB/cm/MHz, and 0.83dB/cm/MHz, respectively. The area under the curve (AUC) values were 0.891, 0.929, and 0.914, respectively. When grouped by WC, there was a statistically significant difference in AC value between the normal group and the obese group (t=-4.675, P<0.001). Overall WC and within group WC were moderately correlated with the AC value of UGAP (P<0.001).

Conclusions: UGAP has a good diagnostic value in the quantitative evaluation of liver steatosis in MAFLD, and the change of WC can reflect the occurrence of liver steatosis to a certain extent.

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<![CDATA[Enhanced Regularized Ensemble Encoderdecoder Network for Accurate Brain Tumor Segmentation]]>https://eurekaselect.com/article/1385542024-03-28Background: Segmenting tumors in MRI scans is a difficult and time-consuming task for radiologists. This is because tumors come in different shapes, sizes, and textures, making them hard to identify visually.

Objective: This study proposes a new method called the enhanced regularized ensemble encoder-decoder network (EREEDN) for more accurate brain tumor segmentation.

Methods: The EREEDN model first preprocesses the MRI data by normalizing the intensity levels. It then uses a series of autoencoder networks to segment the tumor. These autoencoder networks are trained using back-propagation and gradient descent. To prevent overfitting, the EREEDN model also uses L2 regularization and dropout mechanisms.

Results: The EREEDN model was evaluated on the BraTS 2020 dataset. It achieved high performance on various metrics, including accuracy, sensitivity, specificity, and dice coefficient score. The EREEDN model outperformed other methods on the BraTS 2020 dataset.

Conclusion: The EREEDN model is a promising new method for brain tumor segmentation. It is more accurate and efficient than previous methods. Future studies will focus on improving the performance of the EREEDN model on complex tumors.

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<![CDATA[Corrigendum: Diagnosis of Benign and Malignant BI-RADS 4 Breast Masses by Contrastenhanced Ultrasound Combined with Shear Wave Elastography]]>https://eurekaselect.com/article/1386072024-03-28 Originals: 1. All CEUS examinations were performed using a Toshiba Aplio500 ultrasound machine and a 9MHz pulse inversion harmonic L9-3 linear array probe.

2. Aixplorer ultrasonic diagnostic instrument manufactured by SuperSonic Imagine company was applied with a probe frequency of 4–15 MHZ. Q-BOXTM analysis software of the instrument was used to determine Young's modulus of breast masses, and the measurement range of Young's modulus was 0–180 kPa (set by the instrument automatically).

Corrected: 1. All CEUS examinations were performed using a Philips EPIQ5 ultrasound machine and a 9MHz pulse inversion harmonic L4-18 linear array probe.

2. Aixplorer ultrasonic diagnostic instrument manufactured by Philips company was applied with a probe frequency of 18 MHZ. Q-BOXTM analysis software of the instrument was used to determine Young's modulus of breast masses, and the measurement range of Young's modulus was 0–180 kPa (set by the instrument automatically).

The original article can be found online at https://www.eurekaselect.com/article/135750]]> <![CDATA[Dual-energy CT Portal Venography: Clinical Application Values and Future Opportunities]]>https://eurekaselect.com/article/1386442024-03-28 <![CDATA[Relationships between Size-specific Dose Estimate and Signal to Noise Ratio under Chest CT Examinations with Tube Current Modulation]]>https://eurekaselect.com/article/1386402024-03-28Purpose: Exploring the relationship between the signal-to-noise ratio (SNR) of organs and size-specific dose estimate (SSDE) in tube current modulation (TCM) chest CT examination.

Methods: Forty patients who received TCM chest CT scanning were retrospectively collected and divided into four groups according to the tube voltage and sexes. We chose to set up the region of interest (ROI) at the tracheal bifurcation and its upper and lower parts in slice images of the heart, aorta, lungs, paracranial muscles, and female breast, and the SNR of each organ was calculated. We also calculated the corresponding axial volume CT dose index (CTDIvolz) and axial size-specific dose estimate (SSDEz).

Results: The correlation analysis showed that the correlation between the SNR of the slice images of most organs and SSDEz was more significant than 0.8, and that between the SNR and CTDIvol was more significant than 0.7. The simple linear regression analysis results showed that when the sex is the same, the SNR of the same organ at 100kVp was higher than 120kVp, except for the lung. In multiple regression analysis, the result indicated that the determination coefficients of the SNR and SSDEz of the four groups were 0.934, 0.971, 0.905, and 0.709, respectively.

Conclusion: In chest CT examinations with TCM, the correlation between the SNR of each organ in slice images and SSDEz was better than that of CTDIvolz. And when the SSDEz was the same, the SNR at 100 kVp was better than that at 120 kVp.

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<![CDATA[Fusion of Multimodal Medical Images based on Fine-grained Saliency and Anisotropic Diffusion Filter]]>https://eurekaselect.com/article/1380062024-03-28Background: A clinical medical image provides vital information about a person's health and bodily condition. Typically, doctors monitor and examine several types of medical images individually to gather supplementary information for illness diagnosis and treatment. As it is arduous to analyze and diagnose from a single image, multi-modality images have been shown to enhance the precision of diagnosis and evaluation of medical conditions.

Objective: Several conventional image fusion techniques strengthen the consistency of the information by combining varied image observations; nevertheless, the drawback of these techniques in retaining all crucial elements of the original images can have a negative impact on the accuracy of clinical diagnoses. This research develops an improved image fusion technique based on fine-grained saliency and an anisotropic diffusion filter to preserve structural and detailed information of the individual image.

Methods: In contrast to prior efforts, the saliency method is not executed using a pyramidal decomposition, but rather an integral image on the original scale is used to obtain features of superior quality. Furthermore, an anisotropic diffusion filter is utilized for the decomposition of the original source images into a base layer and a detail layer. The proposed algorithm's performance is then contrasted to those of cutting-edge image fusion algorithms.

Results: The proposed approach cannot only cope with the fusion of medical images well, both subjectively and objectively, according to the results obtained, but also has high computational efficiency.

Conclusion: Furthermore, it provides a roadmap for the direction of future research.

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<![CDATA[Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Diagnosed in Adulthood]]>https://eurekaselect.com/article/1386422024-03-28Introduction: An anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare heart malformation, with 90% of patients dying during the first year of life. If the right coronary artery compensation and multiple collateral circulation are sufficiently established, the patient's myocardial ischemia symptoms are mild and appear later, which is called the adult type ALCAPA.

Case Description: A 42-year-old woman presented to our hospital with one-month history of the aggravation of active shortness of breath which gradually progressed to nocturnal paroxysmal shortness of breath and cough. Admission physical examination suggested mild edema of both lower limbs. Transthoracic echocardiography (TTE) showed that a small vessel shadow was abnormally connected to the pulmonary artery (PA), and moderate pulmonary artery hypertension. Coronary computed tomography angiography (CTA) showed an anomalous origin of the left main coronary artery (LMCA) dividing into the left anterior descending (LAD) and left circumflex (LCX) artery from the PA, with no clear connection to the left coronary sinus. The right coronary artery (RCA) was significantly dilated and originated from the normal Valsalva sinus. It was accompanied by multiple collateral circulations, most of which traveled anterior to the right ventricular free wall and anterior interventricular sulcus, and some emanated from the posterior descending branch of the posterior interventricular sulcus and walked toward the posterolateral wall of the left ventricle.

Conclusion: Coronary computed tomography angiography (CTA) can be used to visualize the abnormal origin and distribution of the coronary artery's course and may be the first choice in the diagnosis of ALCAPA.

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<![CDATA[T1 Mapping and Amide Proton Transfer Weighted Imaging for Predicting Lymph Node Metastasis in Patients with Rectal Cancer]]>https://eurekaselect.com/article/1383952024-03-28Background: Accurate preoperative judgment of lymph node (LN) metastasis is a critical step in creating a treatment strategy and evaluating prognosis in rectal cancer (RC) patients.

Objective: This study aimed to explore the value of T1 mapping and amide proton transfer weighted (APTw) imaging in predicting LN metastasis in patients with rectal cancer.

Methods: In a retrospective study, twenty-three patients with pathologically confirmed rectal adenocarcinoma who underwent MRI and surgery from August 2019 to August 2021 were selected. Then, 3.0T/MR sequences included conventional sequences (T1WI, T2WI, and DWI), APTw imaging, and T1 mapping. Patients were divided into LN metastasis (group A) and non-LN metastasis groups (group B). The intra-group correlation coefficient (ICC) was used to test the inter-observer consistency. Mann-Whitney U test was used to compare the differences between the two groups. Spearman correlation analysis was performed to evaluate the correlation between T1 and APT values. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the differential performance of each parameter and their combination. The difference between AUCs was compared using the DeLong test.

Results: The APT value in patients with LN metastasis was significantly higher than in those without LN metastasis group (P=0.020). Also, similar results were observed for the T1 values (P=0.001). The area under the ROC curve of the APT value in the prediction of LN metastasis was 0.794; when the cutoff value was 1.73%, the sensitivity and specificity were 71.4% and 88.9%, respectively. The area under the ROC curve of the T1 value was 0.913; when the cutoff value was 1367.36 ms, the sensitivity and specificity were 78.6% and 100.0%, respectively. The area under the ROC curve of T1+APT was 0.929, with a sensitivity of 78.6% and specificity of 100.0%.

Conclusion: APT and T1 values show great diagnostic efficiency in predicting LN metastasis in rectal cancer.

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<![CDATA[Empirical Curvelet-ridgelet Wavelet Transform for Multimodal Fusion of Brain Images]]>https://eurekaselect.com/article/1380042024-03-28Background: Empirical curvelet and ridgelet image fusion is an emerging technique in the field of image processing that aims to combine the benefits of both transforms.

Objective: The proposed method begins by decomposing the input images into curvelet and ridgelet coefficients using respective transform algorithms for Computerized Tomography (CT) and magnetic Resonance Imaging (MR) brain images.

Methods: An empirical coefficient selection strategy is then employed to identify the most significant coefficients from both domains based on their magnitude and directionality. These selected coefficients are coalesced using a fusion rule to generate a fused coefficient map. To reconstruct the image, an inverse curvelet and ridgelet transform was applied to the fused coefficient map, resulting in a high-resolution fused image that incorporates the salient features from both input images.

Results: The experimental outcomes on real-world datasets show how the suggested strategy preserves crucial information, improves image quality, and outperforms more conventional fusion techniques. For CT Ridgelet-MR Curvelet and CT Curvelet-MR Ridgelet, the authors' maximum PSNRs were 58.97 dB and 55.03 dB, respectively. Other datasets are compared with the suggested methodology.

Conclusion: The proposed method's ability to capture fine details, handle complex geometries, and provide an improved trade-off between spatial and spectral information makes it a valuable tool for image fusion tasks.

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<![CDATA[Disease Course and Pulmonary Involvement of COVID-19 during the Delta Variant Period in Germany: A Comparative Study of Vaccinated and Unvaccinated Patients at a Tertiary Hospital]]>https://eurekaselect.com/article/1387672024-03-28Background: Despite the availability of vaccines, there is an increasing number of SARS-CoV-2-breakthrough-infections.

Objective: The aim of this study was to determine whether there is a radiological difference in lung parenchymal involvement between infected vaccinated and unvaccinated patients. Additionally, we aimed to investigate whether vaccination has an impact on the course of illness and the need for intensive care.

Methods: This study includes all patients undergoing chest computed tomography (CT) or x-ray imaging in case of a proven SARS-CoV-2 infection between September and November 2021. Anonymized CT and x-ray images were reviewed retrospectively and in consensus by two radiologists, applying an internal severity score scheme for CT and x-ray as well as CARE and BRIXIA scores for x-ray. Radiological findings were compared to vaccination status, comorbidities, inpatient course of the patient’s illness and the subjective onset of symptoms.

Results: In total, 38 patients with acute SARS-CoV-2 infection underwent a CT scan, and 168 patients underwent an x-ray examination during the study period. Of these, 32% were vaccinated in the CT group, and 45% in the x-ray group. For the latter, vaccinated patients exhibited significantly more comorbidities (cardiovascular (p=0.002), haemato-oncological diseases (p=0.016), immunosuppression (p=0.004)), and a higher age (p<0.001). Vaccinated groups showed significantly lower extent of lung involvement (severity scores in CT cohort and x-ray cohort both p≤0.020; ARDS 42% in unvaccinated CT cohort vs. 8% in vaccinated CT cohort). Furthermore, vaccinated patients in the CT cohort had significantly less need for intensive care treatment (p=0.040).

Conclusion: Our data suggest that vaccination, in the case of breakthrough infection, favours a milder course of illness concerning lung parenchymal involvement and the need for intensive care, despite negative predictors, such as immunosuppression or other pre-existing conditions.

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<![CDATA[Assessment of the Characteristics of Patent Foramen Ovale Associated with Cryptogenic Stroke]]>https://eurekaselect.com/article/1387662024-03-28Objective: This study aims to comprehensively assess the characteristics of patent foramen ovale (PFO) in relation to Cryptogenic Strok (CS) by utilizing transesophageal echocardiography (TEE) and contrast transthoracic echocardiography (c-TTE) and to identify high-risk factors associated with PFO-related CS.

Background: Transcatheter PFO closure has demonstrated its effectiveness in preventing PFO-related CS. Therefore, understanding the specific structural attributes of PFO associated with CS is imperative.

Methods: Enrollment comprised 113 test patients who experienced CS in conjunction with PFO and 117 control patients diagnosed with migraine with PFO but without a history of stroke. The characteristics of the PFO were observed by TEE and c-TTE. A comparative analysis was undertaken to assess the variations in PFO characteristics between the test patients and controls, and to uncover the independent factors relevant to CS.

Results: The patients in the test group were older than the controls. Both the height and length of the PFO during Valsalva exhibited greater dimensions in the test group when contrasted with controls. Notably, the test group presented higher incidence rates of low-angle PFO (defined as an angle between the inferior vena cava (IVC) and PFO ≤ 10°) and atrial septal aneurysm (ASA) as contrasted with the control group. Right-to-left shunt (RLS) III during Valsalva demonstrated a significantly elevated occurrence within the test group as opposed to the controls. Conversely, RLS II during Valsalva exhibited a significantly higher frequency in the controls in contrast to the tests. No significant disparities were observed between the two groups with respect to RLS I during Valsalva and all grades of RLS at rest. Multivariate analysis revealed that the length of the PFO during Valsalva, the presence of ASA, RLS III during Valsalva and low-angle PFO were independent relevant factors associated with CS.

Conclusions: The length of the PFO tunnel, low-angle PFO, RLS III during Valsalva and the presence of ASA were independent risk factors for CS. The combined utilization of TEE and c-TTE may prove valuable in identifying PFO patients at a heightened risk of CS and in facilitating the screening process for transcatheter PFO closure.

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<![CDATA[Salt-and-pepper Noise Reduction for Medical Images based on Image Fusion]]>https://eurekaselect.com/article/1320562024-03-28Background: During the collection process, the prostate capsula is prone to introduce salt and pepper noise due to gastrointestinal peristalsis, which will affect the precision of subsequent object detection.

Objective: A cascade optimization scheme for image denoising based on image fusion was proposed to improve the peak signal-to-noise ratio (PSNR) and contour protection performance of heterogeneous medical images after image denoising.

Methods: Anisotropic diffusion fusion (ADF) was used to decompose the images denoised by adaptive median filter, non-local adaptive median filter and artificial neural network to generate the base layer and detail layer, which were fused by weighted average and Karhunen-Loeve Transform respectively. Finally, the image was reconstructed by linear superposition.

Results: Compared with the traditional denoising method, the image denoised by this method has a higher PSNR while maintaining the image edge contour.

Conclusion: Using the denoised dataset for object detection, the detection precision of the obtained model is higher.

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<![CDATA[Secondary Degeneration of White Matter Tract following Basal Ganglia Infarction: A Longitudinal Diffusion Tensor Imaging Study]]>https://eurekaselect.com/article/1363842024-03-28Introduction: We explored the relationship between secondary degeneration of white matter (WM) tracts and motor outcomes after left basal ganglia infarction and investigated alterations in the diffusion indices of WM tracts in distal areas.

Methods: Clinical neurological evaluations were accomplished using the Fugl–Meyer scale (FMS). Then, the fractional anisotropy (FA) of the bilateral superior corona radiata (SCR), cerebral peduncle (CP), corticospinal tracts (CST), and corpus callosum (CC) were measured in all patients and control subjects.

Results: Regional-based analysis revealed decreased FA values in the ipsilesional SCR, CP, and CST of the patients, compared to the control subjects at 5- time points. The relative FA (rFA) values of the SCR, CP, and CST decreased progressively with time, the lowest values recorded at 90 days before increasing slightly at 180 days after stroke. Compared to the contralateral areas, the FA values of the ipsilesional SCR and CST areas were significantly decreased (P=0.023), while those of the CP decreased at 180 days (P=0.008). Compared with the values at 7 days, the rFA values of the ipsilesional SCR and CP areas were significantly reduced at 14, 30, and 90 days, while those in the CST area were significantly reduced at 14, 90, and 180 days. The CP rFA value at 7 days correlated positively with the FM scores at 180 days (r=0.469, P=0.037).

Conclusion: This study provides an objective, comprehensive, and automated protocol for detecting secondary degeneration of WM, which is important in understanding rehabilitation mechanisms after stroke.

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<![CDATA[Additional Non-contrast CT to Portal Venous Phase is not Relevant for Patients referred for Colonic Diverticulitis or Sigmoiditis Suspicion]]>https://eurekaselect.com/article/1388502024-03-28Objective: To evaluate the usefulness of unenhanced CT added to the portal venous phase in the diagnostic accuracy of acute colonic diverticulitis/sigmoiditis.

Methods: Between January 1st and December 31st, 2020, all consecutive adult patients referred to the radiology department for clinical suspicion of acute colonic diverticulitis/sigmoiditis were retrospectively screened. To be included, patients must have undergone a CT with both unenhanced (UCT) and contrast-enhanced portal venous phase CT (CECT). CT examinations were assessed for features of diverticulitis, complications, differential diagnosis and incidental findings using UCT + CECT association, medical management, and follow-up as the reference. Radiation doses were recorded on our image archiving system and assessed.

Results: Of the 114 patients included (mean age was 67±18 years; 60% were female), 46 had acute colonic diverticulitis/sigmoiditis. No diagnosis of sigmoiditis/diverticulitis, complication or differential diagnosis was missed with the CECT alone. Apart from diverticulitis, only one 2 mm meatal urinary microlithiasis was missed with no impact on patient management. The confidence level in diagnosis was not increased by UCT. The average DLP of CECT was 450 mGy.cm, and 382 mGy.cm for UCT. The use of a single-phase CECT acquisition allowed a reduction of 45.9% of the irradiation.

Conclusion: Unenhanced CT is not necessary for patients addressed with clinical suspicion of acute colonic diverticulitis/sigmoiditis, and CECT alone protocol must be used.

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<![CDATA[SegEIR-Net: A Robust Histopathology Image Analysis Framework for Accurate Breast Cancer Classification]]>https://eurekaselect.com/article/1383882024-03-28Background: Breast Cancer (BC) is a significant threat affecting women globally. An accurate and reliable disease classification method is required to get an early diagnosis. However, existing approaches lack accurate and robust classification.

Objective: This study aims to design a model to classify BC Histopathology images accurately by leveraging segmentation techniques.

Methods: This work proposes a combined segmentation and classification approach for classifying BC using histopathology images to address these issues. Chan-Vese algorithm is used for segmentation to accurately delineate regions of interest within the histopathology images, followed by the proposed SegEIR-Net (Segmentation using EfficientNet, InceptionNet, and ResNet) for classification. Bilateral Filtering is also employed for noise reduction. The proposed model uses three significant networks, ResNet, InceptionNet, and EfficientNet, concatenates the outputs from each block followed by Dense and Dropout layers. The model is trained on the breakHis dataset for four different magnifications and tested on BACH (BreAst Cancer Histology) and UCSB (University of California, Santa Barbara) datasets.

Results: SegEIR-Net performs better than the existing State-of-the-Art (SOTA) methods in terms of accuracy on all three datasets, proving the robustness of the proposed model. The accuracy achieved on breakHis dataset are 98.66%, 98.39%, 97.52%, 95.22% on different magnifications, and 93.33% and 96.55% on BACH and UCSB datasets.

Conclusion: These performance results indicate the robustness of the proposed SegEIR-Net framework in accurately classifying BC from histopathology images.

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<![CDATA[Combination of Contrast-enhanced FlAIR and Contrast-enhanced T1WI: A Quick and Efficient Method in Detecting Brain Metastases of Lung Cancers]]>https://eurekaselect.com/article/1388492024-03-28Background: Some patients with suspected brain metastases (BM) could not tolerate longer scanning examinations according to the standardized MRI protocol.

Objective: The purpose of this study was to evaluate the clinical value of contrast-enhanced fast fluid-attenuated inversion recovery (CE FLAIR) imaging in combination with contrast-enhanced T1 weighted imaging (CE T1WI) in detecting BM of lung cancer and explore a quick and effective MRI protocol.

Material and Methods: In 201 patients with lung cancers and suspected BM, T1WI and FLAIR were performed before and after administration of gadopentetate dimeglumine. Two radiologists reviewed pre- and post-contrast images to determine the presence of abnormal contrast enhancement or signal intensity and decided whether it was metastatic or not on CE T1WI (Group 1) and CE FLAIR (Group 2). The number, locations and features of abnormal findings in two groups were recorded. Receiver Operating Characteristic (ROC) analyses were conducted in three groups: Group 1, 2 and 3(combination of CE FLAIR and CE T1WI).

Results: A total of 714 abnormal findings were revealed, of which 672 were considered as BM and 42 nonmetastatic. Superficial and small metastases(≤10mm) in parenchyma and ependyma, leptomeningeal and non-expansive skull metastases were typically better seen on CE FLAIR. The areas under ROC in the three groups were 0.720,0.887 and 0.973, respectively. Group 3 was significantly better in diagnostic efficiency of BMs than Group 1 (p<0.0001) or Group 2 (p=0.0006).

Conclusion: The combination of CE T1WI and CE FLAIR promotes diagnostic performance and results in better observation and characterization of BM in patients with lung cancers. It provides a quick and efficient way of detecting BM.

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<![CDATA[The Correlation between Region-specific Epicardial Adipose Tissue and Myocardial Ischemia Defined by CT-FFR in Type 2 Diabetes Mellitus Patients]]>https://eurekaselect.com/article/1388482024-03-28Background: Epicardial Adipose Tissue (EAT) accumulation is closely associated with the presence and severity of coronary artery disease (CAD), myocardial ischemia, plaque vulnerability, and major adverse cardiovascular events.

Objective: The aim of this study was to investigate the correlation between myocardial ischemia defined by computed tomography-derived fractional flow reserve (CT-FFR) and region-specific EAT in patients with type 2 diabetes mellitus (T2DM).

Methods: Between January 2022 and May 2023, 200 T2DM patients were randomly selected from the Department of Endocrinology in The Central Hospital of Wuhan. These patients were divided into two groups based on myocardial ischemia defined by CT-FFR: myocardial ischemia group (152 cases) and control group (48 cases). Both groups of patients used a post-treatment workstation to measure the thickness of region-specific EAT. Receiver operating characteristic (ROC) curve analysis and binary logistic regression were used to evaluate the correlation between various parameters and myocardial ischemia.

Results: Patients in the myocardial ischemia group had significantly higher values of age, male gender, systolic blood pressure, total cholesterol, triglycerides, LDL, HDL, fasting blood glucose, fasting insulin, HOMA-IR, EAT thickness in right ventricular wall, left atrioventricular groove, and superior and inferior interventricular groove. ROC curve analysis results showed that EAT thickness in the left atrioventricular groove had the largest area under the ROC curve for diagnosing myocardial ischemia (0.837 [95% CI 0.766-0.865]; P < 0.001). Binary logistic regression analysis showed that EAT thickness in the left atrioventricular groove was an independent risk factor for myocardial ischemia in patients with T2DM (P < 0.05).

Conclusion: The EAT thickness in the left atrioventricular groove is an independent risk factor for myocardial ischemia in patients with T2DM. Adipose tissue in the left atrioventricular groove region plays a major role in EAT-mediated CAD.

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<![CDATA[A New Approach based on Fuzzy Clustering and Enhancement Operator for Medical Image Contrast Enhancement]]>https://eurekaselect.com/article/1330282024-03-28Background: Image enhancement is a very significant topic in image processing that improves the quality of the images. The methods of image enhancement are classified into 3 categories. They include histogram method, fuzzy logic method and optimal method. Studies on image enhancement are often based on rules: if it's bright then it's brighter, if it's dark then it's darker and using the global approach. So, it's hard to enhance objects in all dark and light areas, as in the medical images.

Objective: Input data is downloaded from the link: http://www.med.harvard.edu/AANLIB.

Methods: This paper introduces a new algorithm for enhancing medical images that is called the medical image enhancement based on cluster enhancement (MIECE). Firstly, the input image is clustered by the algorithm of fuzzy clustering. Then, the upper bound, and lower bound are calculated according to cluster. Next, the sub-algorithm is implemented for clustering enhancement using an enhancement operator. For each pixel, the gray levels for each channel (R, G, B) are transformed with this sub-algorithm to generate new corresponding gray levels. Because after clustering, each pixel belongs to each cluster with the corresponding membership value. Therefore, the output gray level value will be aggregated from the enhanced gray levels by the sub-algorithm with the weight of the corresponding cluster membership value.

Results: This paper experiences the method MIECE with input data downloaded from the link: http://www.med.harvard.edu/AANLIB. The experimental results are compared with some recent methods that include: SGHIE (2017), Ying (2017) and KinD++ (2021).

Conclusion: This paper introduces the new algorithm which is based on cluster enhancement (MIECE) to enhance the medical image contrast. The experimental results show that the output images of the proposed algorithm are better than some other recent methods for enhancing dark objects.

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<![CDATA[Epithelioid Mesothelioma of Peritoneum Masquerading as Peritoneal Carcinomatosis]]>https://eurekaselect.com/article/1390002024-03-28Introduction: Mesothelioma is an insidious neoplasm that develops from mesothelial cells. About 80% of mesotheliomas originate in the pleural cavity. Other sites where it has been reported are the peritoneal cavity, tunica vaginalis, and the pericardium.

Case Presentation: A 45-year-old female complained of abdominal distention and pain for three months. There was a significant weight loss of approximately 15 kg in the past three months, and there was no family history of any malignancy, tuberculosis, substance abuse, or asbestosis exposure. Physical examination revealed signs of muscle wasting, loss of subcutaneous fat, and hollowing of the eye sockets. There was pitting edema in the bilateral lower limbs; per abdomen examination revealed abdominal distension with umbilicus in the midline. No visible peristalsis or dilated veins were seen all over the abdomen. Hernial sites were normal. Gross ascites were present, and no organomegaly, definitive mass, or lump was palpable. The dull note was heard all over the abdomen, and fluid thrill was noted on percussion. Bowel sounds were normal on auscultation. The ascitic fluid examination revealed the presence of atypical cells. An omentectomy was done and it was sent for histopathological examination.

Conclusion: The specimen of omentectomy was in multiple fragments and measured 17x16x3cm; a few of the fragments were nodular, soft to firm on palpation. The cut section of mass was gray and white with areas of necrosis. Microscopic examination showed sheets of malignant cells. These tumor cells were immunoreactive to EMA, cytokeratin, vimentin, calretinin, WT-1, and D2-40 and immune negative to desmin (highlighting only the entrapped reactive mesothelial cells), inhibin, BerEP4, TTF-1, CD 68, napsin, ER, CEA, CDX2, PR, PAX-8, and SALL4. Ki67 labelling index was 15%. The features were of epithelioid mesothelioma.

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<![CDATA[The Effect of Contrast-enhanced Ultrasound <i>via</i> Vessels and Surgical Drains Guidance Percutaneous Catheter Drainage in the Treatment of Pyogenic Liver Abscess]]>https://eurekaselect.com/article/1389982024-03-28Background: Pyogenic liver abscess (PLA) is a purulent disease caused by microbial contamination of liver parenchyma and includes amoebic liver abscess, fungal liver abscess, and the most common bacterial liver abscess.

Objective: Explore the efficacy of contrast-enhanced ultrasound (CEUS) via vessels and surgical drain guidance percutaneous catheter drainage (PCD) in the treatment of pyogenic liver abscesses (PLA).

Materials and Methods: A total of 86 PLA patients who underwent PCD treatment in our hospital from May 2018 to February 2023 were retrospectively selected. Of them, 41 patients were treated under intravenous CEUS guidance (Control group), and 45 patients were treated under CEUS via vessels and surgical drain guidance (study group). Perioperative characteristics, treatment effectiveness, and incidence of complications were analyzed and compared between groups.

Results and Discussion: The duration of surgery, drainage, white blood cell recovery, body temperature recovery, and hospitalization in the study group were longer than those in the control group (P<0.05). The total effective rate of the study group (95.56%) was higher than that of the control group (80.49%) (P<0.05). The incidence of complications in the study group (4.44%) was lower than that in the control group (19.51%) (P<0.05).

Conclusion: Compared with intravenous CEUS alone, treatment under CEUS via vessels and surgical drains-guided PCD was associated with shorter surgical time, faster recovery, better treatment effect, lower risk of complications, and ensured treatment safety in PLA patients.

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<![CDATA[The Diagnostic Value of Abnormal Bone Marrow Signal Changes on Magnetic Resonance Imaging: Is Bone Marrow Biopsy Essential?]]>https://eurekaselect.com/article/1389972024-03-28Background: It is essential to determine whether bone marrow signal changes on magnetic resonance imaging (MRI) represent a physiological response or pathology; at present, the clinical significance of these signal changes is unclear. It is unknown whether a bone marrow biopsy is required when bone marrow signal changes are detected incidentally in individuals without suspected malignancy.

Objective: The primary purpose of this study was to determine whether incidentally detected bone marrow signal changes on MRI performed for various reasons (at the time of admission or during follow-up) are clinically significant.

Methods: We retrospectively evaluated the bone marrow biopsy clinical and laboratory findings of 42 patients with incidental bone marrow signal changes on MRI between September 2016 and January 2020. We also determined whether the patients were diagnosed with malignancy during admission or follow-up.

Results: Of the 42 patients, three (7%) were diagnosed with hematological malignancies during admission, while two were diagnosed with multiple myeloma and one with B-cell acute lymphoblastic leukemia. Of the 42 patients, 35 had a mean follow-up of 40.6 ± 5.3 months. One patient was diagnosed with monoclonal gammopathy of undetermined significance four months after their first admission.

Conclusions: In addition to MRI, detailed clinical and laboratory evaluations should be performed to inform the decision for bone marrow biopsy and exclude hematological malignancy. If there is any doubt, a bone marrow biopsy should be performed. Moreover, since bone marrow signal changes may be a preliminary finding, follow-up of these patients is essential.

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<![CDATA[A Case Report of Diffuse-type Tenosynovial Giant Cell Tumor as a Calcaneus Mass: A Diagnostic Challenge]]>https://eurekaselect.com/article/1389992024-03-28Introduction: Diffuse-type tenosynovial giant cell tumor (D-TGCT) originates from synovial cells in tendon sheaths and bursae and rarely presents as a calcaneal mass.

Case Report: A 44-year-old female presented with left heel pain that had persisted for over a year and had worsened over the past six months. A mass was found on the Lateral radiograph of the calcaneus, which was diagnosed as an aneurysmal bone cyst. Non-contrast computed tomography (CT) and magnetic resonance imaging (MRI)diagnosed a benign tumor. Based on light microscopy, special stains, and immunohistochemistry, a final diagnosis of diffuse tenosynovial giant cell tumor (D-TGCT) was rendered.

Results: D-TGCT is a slow-growing, infiltrative tumor that can form single or multiple masses outside the joint, and can also involve adjacent jointsmainly affects weight-bearing joints such as the knee, hip, and ankle. However, D-TGCT presents as a calcaneal mass, which poses a diagnostic challenge for all radiologists.

Conclusion: A calcaneal mass exhibiting well-defined borders, focal cortical destruction, a sclerotic rim, and T2WI hypointensity, the possibility of D-TGCT should be considered.

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<![CDATA[A Case of Nasal Extranodal NK/T-cell Lymphoma of Lower Limb Muscle Revealed by 18F-FDG PET/CT]]>https://eurekaselect.com/article/1389962024-03-28Background: Extranodal NK/T-cell lymphoma (ENKTCL) is a type of malignant non-Hodgkin’s lymphoma originating from mature T cells and NK cells, mainly involving the upper aerodigestive tract, including the nasal cavity, nasopharynx, oropharynx, oral cavity, hypopharynx, larynx, and occasionally the skin, salivary glands, testes, and gastrointestinal tract, but rarely the skeletal muscle.

Case Presentation: An 82-year-old man presented with redness, swelling, and pain in his right lower limb for 3 months. He was initially diagnosed with cellulitis at another hospital and was treated conservatively for two weeks without improvement. He underwent a biopsy of the lesioned muscle and histopathology revealed nasal type ENKTCL. 18F-FDG PET/CT was recommended for the staging of the lymphoma, and the results showed that except for the muscles of the right lower extremity, no other organs and tissues were involved.

Conclusion: ENKTCL confined to the muscle of the lower extremity is rare and often initially misdiagnosed as myositis because of red, swollen, heat, and painful symptoms that resemble inflammation, and in it, higher radiotracer uptake in 18F-FDG PET/CT helps to distinguish it from myositis.

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<![CDATA[Another CCTA Incidental Finding: Case Report of an Idiopathic Pulmonary Vein Pseudo-thrombosis]]>https://eurekaselect.com/article/1391712024-03-28Introduction: While pulmonary vein filling defects on CT are typically considered diagnostic for thrombus, under certain circumstances, they can be artifactual as a result of flow phenomena.

Case Presentation: We report a case of a 53-year-old female with chest pain who was found to have filling defects in pulmonary vein branches on CCTA that were initially treated as thromboses. However, follow-up cardiac MRI was negative for thrombi, and pseudo-thrombosis was therefore diagnosed.

Conclusion: Pulmonary vein pseudo-thrombosis should be considered in the differential diagnosis of pulmonary vein filling defects.

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<![CDATA[Modular Edge Analysis Reveals Chemotherapy-induced Brain Network Changes in Lung Cancer Patients]]>https://eurekaselect.com/article/1369052024-03-28Background: Lung cancer patients with post-chemotherapy may have disconnected or weakened function connections within brain networks.

Objective: This study aimed to explore the abnormality of brain functional networks in lung cancer patients with post-chemotherapy by modular edge analysis.

Methods: Resting-state functional magnetic resonance imaging (rs-fMRI) scans were performed on 40 patients after chemotherapy, 40 patients before chemotherapy and 40 normal controls. Patients in all three groups were age and sex well-matched. Then, modular edge analysis was applied to assess brain functional network alterations.

Results: Post-chemotherapy patients had the worst MoCA scores among the three groups (p < 0.001). In intra-modular connections, compared with normal controls, the patients after chemotherapy had decreased connection strengths in the occipital lobe module (p < 0.05). Compared with the nonchemotherapy group, the patients after chemotherapy had decreased connection strengths in the subcortical module (p < 0.05). In inter-modular connections, compared with normal controls, the patients after chemotherapy had decreased connection strength in the frontal-temporal lobe modules (p < 0.05). Compared with the non-chemotherapy group, the patients after chemotherapy had decreased connection strength in the subcortical-temporal lobe modules (p < 0.05).

Conclusion: The results reveal that chemotherapy can disrupt connections in brain functional networks. As far as we know, the use of modular edge analysis to report changes in brain functional brain networks associated with chemotherapy was rarely reported. Modular edge analysis may play a crucial part in predicting the clinical outcome for the patients after chemotherapy.

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<![CDATA[The Value of Nerve Ultrasound to Diagnose and Follow Up the Multifocal Neurolyphomatosis in the Upper Limb---- Case Report and Literature Review]]>https://eurekaselect.com/article/1391702024-03-28Introduction: Neurolymphomatosis (NL) is a rare disease. Ultrasound (US) plays a crucial role in diagnosing and following up the NL.

Case Presentation: A 59-year-old man was hospitalized with acute pain in the left upper extremity. Ultrasound revealed segmental swelling of multiple nerves around his left elbow with abundant blood flow signals. Contrast-Enhanced Ultrasound (CEUS) showed a rapid, complete and homogenous enhancement in the nerve lesions in the early arterial phase. The NL was confirmed by imaging and flow cytometry, and he accepted chemotherapy. The posttherapeutic ultrasound showed that the nerves in the left upper limb were basically normal. Unfortunately, the patient died of cerebral metastasis in 5 months.

Conclusion: The nerve US and CEUS can show specific manifestations and provide more diagnostic information about NL.

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<![CDATA[A Retrospective Analysis of the Computed Tomography Findings and Diagnosis of 53 Cases of Elastofibroma in the Infrascapular Region]]>https://eurekaselect.com/article/1371502024-03-28Objective: In this work, we have used histopathology as the gold standard for the diagnosis, calculated the sensitivity and positive predictive value (PPV) of computed tomography (CT), and analyzed the CT and clinical characteristics of pathologically proven elastofibromas.

Methods: A systematic retrospective analysis was performed on all patients with infrascapular lesions who were treated in the hospital from 2006 to 2018. CT and histopathological examinations were performed for all cases, and the CT sensitivity and PPV for the diagnosis of elastofibroma were calculated. 12 of 53 cases (20 lesions) underwent enhanced CT scan after CT plain scan, and the related clinical and CT features of elastofibromas have been discussed.

Results: Of the 54 patients treated during the study, CT diagnosis was consistent with histopathology in 53 cases. One was a false-positive patient. The PPV and sensitivity of the CT in the diagnosis of elastofibroma were 93.3% (95% CI 68.0%-99.8%) and 100%, respectively. The CT values of 12 patients with 20 lesions on plain and enhanced scans were statistically significant (P=0.001). The prevalence of elastofibromas in males and females was statistically significant (P=.000). There was no statistically significant difference in the incidence of left and right elastofibromas (P=0.752). There was no significant difference in the volume of left and right lesions (P=0.209) and the volume of elastofibromas between males and females (P=.474).

Conclusion: CT is the most practical tool for the evaluation of elastofibromas in the infrascapular region.

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<![CDATA[Does Post-/Long-COVID-19 Affect Renal Stiffness without Causing any Chronic Systemic Disorders?]]>https://eurekaselect.com/article/1388022024-03-28Background: In the last few years, coronavirus disease 2019 (COVID-19) has changed human lifestyle, behavior, and perception of life. This disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). In the literature, there are limited studies about the late renal effects of COVID-19 that reflect the systemic involvement of this disease.

Aim: In the present study, we aimed to compare sonoelastographic changes in both kidneys between patients who had totally recovered from COVID-19 and healthy individuals using strain wave elastography (SWE).

Methods: This study was conducted between June 2021 and May 2022 in Kahramanmaraş City Hospital Department of Radiology. File and archive records were retrospectively evaluated. Basic demographic, laboratory, and renal ultrasonography (USG) and sonoelastographic findings were screened and noted. Two groups were defined to compare sonoelastographic findings. Post-/long-COVID-19 group had 92 post-long COVID-19 patients, and the comparator group comprised healthy individuals”. Both groups’ demographic, laboratory, and ultrasound-elastographic findings were assessed.

Results: The post-long COVID-19 group had a higher renal elastographic value than the comparator group (1.52 [0.77–2.3] vs. 0.96 [0.54–1.54], p<0.001). There were no statistically significant differences between the two groups in terms of age (p=0.063), gender (p=0.654), or body mass index (BMI) (p=0.725), however, there was a significant difference observed between the two groups in the renal strain ratio (RSR). According to an receiver operating characteristic curve (ROC) analysis, an RSR cutoff of >1.66 predicted post-long COVID-19 with 44.9% sensitivity and 81.9% specificity. (AUC=0.655, p<0.001). A separate ROC analysis was performed to predict post-long COVID-19 with a BMI cutoff of <33.52, kg/m2 sensitivity of 92.4% and specificity of 17% (AUC=0.655, p<0.001).

Conclusion: We demonstrated that renal parenchymal stiffness increases with SWE in post-long COVID-19 patients.]]> <![CDATA[Application Exploration of Medical Image-aided Diagnosis of Breast Tumour Based on Deep Learning]]>https://eurekaselect.com/article/1388042024-03-28Background: Nowadays, people attach increasing importance to accurate and timely disease diagnosis and personalized treatment. Because of the uncertainty and latency of the pathogenesis, it is difficult to detect breast tumour early. With higher resolution, magnetic resonance imaging (MRI) has become an important method for early detection of cancer in recent years. At present, DL technology can automatically study imaging features of different depths.

Objective: This work aimed to use DL to study medical image-assisted diagnosis.

Methods: The image data were collected from the patients. ROI (region of interest) containing the complete tumor area in the medical image was generated. The ROI image was extracted, and the extracted feature data were expanded. By constructing a three-dimensional (3D) CNN model, the evaluation indicators of breast tumour diagnosis results have been proposed. In the experiment part, 3D CNN model and other models have been used to diagnose the medical image of breast tumour.

Results: The 3D CNN model exhibited good ROI region extraction effect and breast tumor image diagnosis effect, and the average diagnostic accuracy of breast tumor image diagnosis was 0.736, which has been found to be much higher than other models and could be applied to breast tumor medical image-aided diagnosis.

Conclusion: The 3D CNN model has been trained by combining the two-dimensional CNN training mode, and the evaluation index of diagnostic results has been established. The experimental part verified the medical image diagnosis effect of the 3D CNN model. The model had exhibited a high ROI region extraction effect and breast tumor image diagnosis effect.

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<![CDATA[Clinical and Temporal Radiological Findings from Critical Patients with COVID-19 Pneumonia: A Descriptive Study]]>https://eurekaselect.com/article/1359182024-03-28Background: In late December 2019, Wuhan, the capital of Hubei Province, China, became the center of an outbreak of pneumonia caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2).

Introduction: The radiological changes in the lungs of critical people with coronavirus disease 2019 (COVID-19) pneumonia at different times have not been fully characterized. We aim to describe the computed tomography findings of patients with critical COVID-19 pneumonia at different disease stages.

Methods: Clinical and laboratory features of critical patients were assessed. CT scans were assigned to groups 1, 2, 3, or 4 based on the interval from symptom onset (within 2 weeks; ≥ 2-4 weeks; ≥ 4-6 weeks; or ≥ 6 weeks, respectively). Imaging features were analyzed and compared across the four groups. Total CT scores, corresponding periods of laboratory findings, and glucocorticoid dosages during the imaging intervals were longitudinally observed in five patients with complete data.

Results: All 11 critical patients (median age: 60 years [42-69]) underwent a total of 40 CT examinations, and the acquisition times ranged from 1-59 days after symptom onset. Median total CT scores were 18 (9-25.25); 445 (42.88-47.62); 4375 (38.62-49.38); and 42 (32.25-53.25) in groups 1, 2, 3, and 4, respectively. The observed lesions were mainly bilateral (37 [92.5%]). The median values of involved lung segments were 10.5 (4.5-13.5); 17 (16-18.5); 18 (18-19.5); and 18 (18-19) in groups 1-4, respectively. The predominant patterns of observed abnormalities were ground-glass opacities (GGO) (9 [90%]); GGO with reticulation and mixed patterns (3 [37.5%] for both); GGO with consolidation (3 [30%]); and GGO with reticulation (8 [66.7%]) in groups 1-4, respectively. Patients developed fibrotic manifestations at later stages.

Conclusion: Critical patients with COVID-19 infection generally presented with temporally changing abnormal CT features from focal unilateral to diffuse bilateral GGO and consolidation that progressed to or coexisted with reticulation in the long term after symptom onset. Low-dose glucocorticoids may be effective in patients with interstitial changes on CT findings.

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<![CDATA[Prediction of Lymphovascular Space Invision in Endometrial Cancer based on Multi-parameter MRI Radiomics Model]]>https://eurekaselect.com/article/1392622024-03-28Objective: To explore the application value of a combined model based on multi-parameter MRI radiomics and clinical features in preoperative prediction of lymphatic vascular space invasion (LVSI) in endometrial carcinoma (EC).

Methods: This retrospective study collected the clinicopathological and imaging data of 218 patients with EC in Yuncheng Central Hospital from March 2018 to May 2022. The patients were randomly divided into training group (n=152) and validation group (n= 66) according to the ratio of 7: 3. Based on the ADC, CE-sag, CE-tra, DWI, T2WI-sag-fs, T2WI-tra sequence images of each patient, the region of interest was manually segmented and the features were extracted. The four-step dimensionality reduction method based on max-relevance and min-redundancy (MRMR) and least absolute shrinkage and selection operator (LASSO) regression was used for feature selection and radiomics model construction. Independent predictors of clinicopathological features were screened by multivariate logistic regression analysis. The imaging model based on ADC, CE-sag, CE-tra, DWI, T2WI-sag-fs, T2WI-tra single sequence and combined sequence and the fusion model with clinicopathological features were constructed, and the nomogram was made. ROC curve, correction curve and decision analysis curve were used to evaluate the efficacy and clinical benefits of the nomogram.

Results: There was no significant difference in general clinical data between the training and validation groups (P > 0.05). After screening the extracted features, 16 radiomics features were obtained, which were all related to LVSI in EC patients (P < 0.05). The area under the ROC curve (AUC) of the six independent sequence radiomics models in the training group was 0.807, 0.794, 0.826, 0.794, 0.828, 0.824, respectively. The AUC corresponding to the radiomics model constructed by the combined sequence was 0.884, and the diagnostic efficiency was the best, which was verified in the validation group. The AUC of the nomogram constructed by the combined radiomics model and age maximum tumor diameter(MTD), lymph node enlargement (LNE) in the training group and the validation group were 0.914 and 0.912, respectively. The correction curve shows that the nomogram has good correction performance. The decision curve suggests that taking radiomics nomogram to predict LVSI net benefit when the risk threshold is > 10% is better than considering all patients as LVSI+ or LVSI-.

Conclusion: The combined model based on multi-parametric MRI radiomics features and clinical features has good predictive value for LVSI status in EC patients.

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<![CDATA[Diagnostic Strategy for Suspected Unilateral Absence of the Pulmonary Artery]]>https://eurekaselect.com/article/1392612024-03-28Background: Unilateral absence of the pulmonary artery (UAPA) is a very rare congenital anomaly.

Objective: To analyze the diagnostic strategy applied to seven patients with UAPA who were examined and subsequently treated at the National Lung Hospital, Hanoi, Vietnam.

Methods: All seven patients, including three pediatric cases (1, 2, and 14 years old) and four adult cases (21, 26, 44, and 53 years old), had a history of recurrent pneumonia, and the clinical symptoms on admission included cough, progressive dyspnea, chest pain, and fatigue. The patients were initially examined clinically, followed by hematological testing, blood biochemistry testing, and chest X-ray radiology. The results suggested UAPA, so echocardiography and contrast-enhanced chest computed tomography (CT) were performed as soon as practical.

Results: The echocardiographic and CT imaging findings confirmed the suspected diagnosis of UAPA in all seven patients, which was accompanied by congenital heart disease in three patients. Three of the seven patients had mild and medium pulmonary hypertension. All seven patients were treated with drugs, which led to improvement in symptoms.

Conclusion: Frontal chest X-ray provided the initial signs suggesting a diagnosis of UAPA. Subsequent echocardiography and contrast-enhanced chest CT were effective diagnostic tools for fast and accurate confirmation of UAPA.

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<![CDATA[The Relationship between Quantitative Parameters of Dual-energy CT and HIF-1α Expression in Non-Small Cell Lung Cancer]]>https://eurekaselect.com/article/1392592024-03-28Objective: This study aimed to investigate whether there is a correlation between quantitative parameters of dual-energy computed tomography (DECT) and the relative expression of HIF-1α in patients with non-small cell lung cancer (NSCLC) to preliminarily explore the value of DECT in evaluating the hypoxia of tumor microenvironment and tumor biological behavior and provide more information for the treatment of NSCLC.

Methods: This retrospective research included 36 patients with pathologically confirmed NSCLC who underwent dual-energy enhanced CT scans. The quantitative parameters of DECT were analyzed, including iodine concentration, water concentration, the CT values corresponding to 40keV, 70keV, 100keV, and 130keV in arterial and venous phases, and the normalized iodine concentration and the slope of the energy spectrum curve were calculated. Postoperative specimens underwent HIF immunohistochemical staining by two pathologists. Spearman correlation analysis was adopted as the statistical methodology. The data were analyzed by SPSS26.0 statistical software.

Results: Water concentration (r=0.659, P<0.001 and r= 0.632, P<0.001, the CT values corresponding to 100keV (r=0.645, P<0.001 and r= 0.566, P<0.001) and 130keV (r=0.687, P<0.001 and r= 0.682, P<0.001) in arterial and venous phases, and CT value of 70keV in arterial phase (r=0.457, P=0.005) were positively correlated with HIF-1α expression level. There was no correlation among iodine concentration, standardized iodine concentration, CT value of 40keV, λHU, and HIF-1α expression in arterial and venous levels (P >0.05).

Conclusion: The quantitative parameters of DECT have a certain correlation with HIF-1α expression in NSCLC. Moreover, it has been demonstrated that DECT can be used to predict hypoxia in tumor tissues and the prognosis of lung cancer patients.

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<![CDATA[Clinical Presentations, MDCT Features, and Treatment of Three Types of Adult Intussusceptions Based on the Location]]>https://eurekaselect.com/article/1386272024-03-28Purpose: This study aimed to explore the similarities and differences in clinical presentations, multidetector computed tomographic (MDCT) features, and treatment of three types of adult intussusceptions based on location.

Methods: We retrospectively reviewed 184 adult patients with 192 intussusceptions. Depending on the location, intussusceptions were classified as enteric, ileocolic, and colonic types. The similarities and differences of clinical presentations, MDCT features, and treatment of three types of adult intussusception were compared. Meanwhile, the three types of intussusceptions were further divided into surgical and conservative groups based on the treatment. Uni- and multivariate logistic analyses were used to identify risk factors for intussusception requiring surgery.

Results: Enteric and ileocolic intussusceptions were mainly presented with abdominal pain (78.46% and 85.71%). Hematochezia/melena (64.29%) was the main symptom of colonic intussusception. On MDCT, ileocolic intussusceptions were longer in length and had more signs of intestinal necrosis (hypodense layer, fluid collection and no/poor bowel wall enhancement) than enteric and colonic intussusceptions. Moreover, it was found that 93.88% (46/49) of ileocolic intussusception and 98.59% (70/71) of colonic intussusception belonged to the surgical group, whereas only 43.06% (31/72) of enteric intussusception belonged to the surgical group. Intussusception length (OR=1.171, P=0.028) and discernible lead point on MDCT (OR=21.003, P<0.001) were reliable indicators of enteric intussusception requiring surgery.

Conclusion: Ileocolic intussusception may be more prone to intestinal necrosis than enteric and colonic intussusceptions, requiring more attention from clinicians. Surgery remains the treatment of choice for most ileocolic and colonic intussusceptions. Less than half of enteric intussusceptions require surgery, and MDCT features are effective in identifying them.

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<![CDATA[Evaluation of the Atherogenic Effect of Covid-19 Pneumonia on Coronary and Carotid Arteries in Patients who Recovered from the Disease]]>https://eurekaselect.com/article/1390142024-03-28Background: Acute inflammation induced by COVID-19 may lead to atherosclerotic plaque development or complicate existing plaque. In this study, we aimed to determine the atherogenic effect of COVID-19 pneumonia, confirmed by thoracic computed tomography, on coronary and carotid arteries in patients who recovered from the disease.

Methods: Our study included patients who were diagnosed with COVID-19 in our hospital at least 1 year ago, recovered, and then underwent coronary CT angiography with suspected coronary artery disease. The aim was to evaluate the burden of atherosclerotic plaque in the coronary arteries of these patients who underwent coronary CT angiography.

Results: Patients were assigned to 3 groups according to the results of the CT scan. Group 1 included patients in the control group with no history of COVID-19 (n=36), group 2 included those with mild to moderate pneumonia symptoms (n=43), and group 3 included those with severe pneumonia symptoms (n=29). The calcium scores were 23.25±36.8 in group 1, 27.65±33.4 in group 2, and 53.58±55.1 in group 3. The calcium score was found to be significantly higher in group 3 patients with severe pneumonia (group 1-2 p=0.885, group 1-3 p<0.05, group 2-3 p<0.05).

Conclusion: Although there is no conclusive evidence of a relationship between COVID-19 and atherosclerosis, our study suggests a possible relationship between them. Since this relationship was found especially in cases with severe disease in our study, we believe that the treatment should focus on preventing excessive inflammatory response, and such patients should be under control in terms of coronary artery disease.

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<![CDATA[Imaging Features and Misdiagnosis of Giant Cerebral Cavernous Malformations]]>https://eurekaselect.com/article/1371762024-03-28Background: While cerebral cavernous malformations (CCMs) have been extensively described, few reports have described the imaging appearance of giant CCMs (GCCMs).

Objective: To describe the imaging characteristics of GCCMs and study the reasons for preoperative misdiagnosis.

Methods: We retrospectively analyzed the data of 12 patients (5 men, 7 women; mean age, 35.23 ± 12.64 years) with histopathologically confirmed GCCMs. Two radiologists analyzed the CT (n = 12) and MRI (n = 10) features: location, number, size, shape, boundary, signal intensity, and enhancement.

Results: The sellar region, cerebral hemisphere, skull bone, and ventricle were involved in 5, 4, 2, and 1 patients, respectively. Three tumors were irregularly shaped, while nine were oval. Eleven lesions showed slightly high- and/or high-density on CT; 1 lesion appeared as a low-density cyst. Calcifications were found in 11 lesions. Four tumors showed uniform hypointensity on T1-weighted imaging (T1WI) and hyperintense signals on T2-weighted imaging (T2WI). Six tumors showed mixed low-, equal-, and high-intensity signals on T1WI and T2WI. Noticeable contrast enhancement and gradual strengthening were noted on T1WI. Ten lesions showed hemorrhage and hemosiderin deposition. The GCCMs were wrongly diagnosed as cartilage-derived tumors/ meningioma (3 patients); tumor and hematoma (2 patients each); and pituitary tumor/ meningioma, chondroma, chordoma, ependymoma, and macroadenoma (1 patient each).

Conclusions: GCCMs present as an oval mass with slightly high- and/or high-density calcifications on CT and show hemorrhage and hemosiderin accumulation on MRI. Therefore, slightly high- and/or high-density calcification and hemosiderin accumulation are critical clinical characteristics of GCCMs.

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<![CDATA[Predicting One-year Recurrence of HCC based on Gadoxetic Acid-enhanced MRI by Machine Learning Models]]>https://eurekaselect.com/article/1390172024-03-28Objective: Accurate prediction of recurrence risk after resction in patients with Hepatocellular Carcinoma (HCC) may help to individualize therapy strategies. This study aimed to develop machine learning models based on preoperative clinical factors and multiparameter Magnetic Resonance Imaging (MRI) characteristics to predict the 1-year recurrence after HCC resection.

Methods: Eighty-two patients with single HCC who underwent surgery were retrospectively analyzed. All patients underwent preoperative gadoxetic acidenhanced MRI examination. Preoperative clinical factors and MRI characteristics were collected for feature selection. Least Absolute Shrinkage and Selection Operator (LASSO) was applied to select the optimal features for predicting postoperative 1-year recurrence of HCC. Four machine learning algorithms, Multilayer Perception (MLP), random forest, support vector machine, and k-nearest neighbor, were used to construct the predictive models based on the selected features. A Receiver Operating Characteristic (ROC) curve was used to assess the performance of each model.

Results: Among the enrolled patients, 32 patients experienced recurrences within one year, while 50 did not. Tumor size, peritumoral hypointensity, decreasing ratio of liver parenchyma T1 value (ΔT1), and α-fetoprotein (AFP) levels were selected by using LASSO to develop the machine learning models. The area under the curve (AUC) of each model exceeded 0.72. Among the models, the MLP model showed the best performance with an AUC, accuracy, sensitivity, and specificity of 0.813, 0.742, 0.570, and 0.853, respectively.

Conclusion: Machine learning models can accurately predict postoperative 1-year recurrence in patients with HCC, which may help to provide individualized treatment.

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<![CDATA[Real-time Strain-encoding Cardiovascular MRI for Assessment of Regional Heart Function in Tetralogy of Fallot Patients]]>https://eurekaselect.com/article/1343652024-03-28Background: Tetralogy of Fallot (ToF) is the most common form of cyanotic congenital heart disease, where right ventricular (RV) function is an important determinant of subsequent intervention.

Objective: In this study, we evaluate the feasibility of fast strain-encoding (fastSENC; a one-heartbeat sequence) magnetic resonance imaging (MRI) for assessing regional cardiac function in ToF.

Methods: FastSENC was implemented to characterize regional circumferential (Ecc) and longitudinal (Ell) strains in the left ventricle (LV) and RV in postrepair ToF. Data analysis was conducted to compare strain measurements in the RV to those in the LV, as well as to those generated by the MRI Tissue-Tracking (MRI-TT) technique, and to assess the relationship between strain and ejection fraction (EF).

Results: Despite normal LVEF (55±8.5%), RVEF was borderline (46±6.4%), but significantly lower than LVEF. RV strains (RV-Ell=-20.2±2.9%, RVEcc=- 15.7±6.4%) were less than LV strains (LV-Ell=-21.7±3.7%, LV-Ecc=-18.3±4.7%), and Ell was the dominant strain component. Strain differences between fastSENC and MRI-TT were less significant in RV than in LV. There existed moderate and weak correlations for RV-Ecc and RV-Ell, respectively, against RVEF. Compared to LV strain, RV strain showed regional heterogeneity with a trend for reduced strain from the inferior to anterior regions. Inter-ventricular strain delay was larger for Ell (64±47ms) compared to Ecc (36±40ms), reflecting a trend for contraction dyssynchrony.

Conclusion: FastSENC allows for characterizing subclinical regional RV dysfunction in ToF. Due to its sensitivity for evaluating regional myocardial contractility patterns and real-time imaging capability without the need for breath-holding, fastSENC makes it more suitable for evaluating RV function in ToF.

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<![CDATA[Research Progress in Tumor Diagnosis Based on Raman Spectroscopy]]>https://eurekaselect.com/article/1335682024-03-28Background: Cancer is a major disease that threatens human life and health. Raman spectroscopy can provide an effective detection method.

Objective: The study aimed to introduce the application of Raman spectroscopy to tumor detection. We have introduced the current mainstream Raman spectroscopy technology and related application research.

Methods: This article has first introduced the grim situation of malignant tumors in the world. The advantages of tumor diagnosis based on Raman spectroscopy have also been analyzed. Secondly, various Raman spectroscopy techniques applied in the medical field are introduced. Several studies on the application of Raman spectroscopy to tumors in different parts of the human body are discussed. Then the advantages of combining deep learning with Raman spectroscopy in the diagnosis of tumors are discussed. Finally, the related problems of tumor diagnosis methods based on Raman spectroscopy are pointed out. This may provide useful clues for future work.

Conclusion: Raman spectroscopy can be an effective method for diagnosing tumors. Moreover, Raman spectroscopy diagnosis combined with deep learning can provide more convenient and accurate detection results.

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<![CDATA[Recurrent Plunging Ranula – A Rare Case Report]]>https://eurekaselect.com/article/1309882024-03-28Background: Plunging ranula is a variant of ranula, which present as a painless subcutaneous anterolateral neck mass and is located beyond the mylohyoid muscle. Plunging ranula is a diagnostic challenge and can present with intraoral component.

Case Report: An elderly male presented with painless neck mass in the cervical region for three months. The mass was excised, and the patient is doing well on follow-up. We report a case of recurrent plunging ranula without any intraoral component.

Conclusion: Whenever the intraoral component is missing in ranula, chances of misdiagnosis and mismanagement are high. Awareness of this entity and high index of suspicion is needed for accurate diagnosis and effective management.

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<![CDATA[The Evaluation of Clinical and Intravoxel Incoherent Motion Parameters of Primary Lesion in Oligometastatic Prostate Cancer]]>https://eurekaselect.com/article/1393552024-03-28Background: In the realm of cancer studies,the differences among the biological behavior of oligometastatic prostate cancer (OPCa), localized prostate cancer (LPCa), and widely prostate cancer (WPCa) are still unclear.

Objectives: The purpose of our study was to assess the clinical and intravoxel incoherent motion (IVIM) parameters of tumor burden in OPCa. In addition, the correlation between clinical and IVIM parameters and the prostate-specific antigen nadir (PSAN) and time to nadir (TTN) during initial androgen deprivation therapy (ADT) in OPCa was explored. It was found that the IVIM parameters could effectively differentiate LPCa and WPCa, as well as LPCa and OPC. Moreover, Gleason score (GS) was positively correlated with PSAN, while prostate volume was positively correlated with TTN.

Methods: About 54 patients were included in this retrospective study (mean age=74±7.4 years). ADC, D, D*, and f were acquired according to the biexponential Diffusion Weighted Imaging (DWI) model. The Kruskal-Wallis test was used to test the differences in clinical and IVIM parameters among the three groups. The Receiver Operating Characteristic (ROC) curve was used to evaluate the discrimination abilities. The Area Under the Curve (AUC) was compared using the DeLong test. Furthermore, Spearman correlation analysis was performed to assess the correlation between clinical and IVIM parameters of PSAN and TTN during initial ADT with OPCa.

Results: There were significant differences among the three groups observed for age, PSA, GS, ADC, D and D* values (P<0.05). Multi-parameter pairwise comparison results showed that significant differences between LPCa and WPCa were observed for the age, PSA, GS, ADC, D and D* values (P<0.05). However, D* was different between the LPCa and OPCa groups (P=0.032). GS showed a significant positive correlation with PSAN (Rho=0.594, P=0.042), and prostate volume showed a significant positive correlation with TTN (Rho=0.777, P=0.003).

Conclusions: The IVIM parameters can effectively differentiate LPCa and WPCa, as well as LPCa and OPCa. Moreover, there was a certain trend in their distribution, which could reflect the tumor burden of PCa.

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<![CDATA[Medical Imaging and Analysis of Thermal Necrosis During Bone Grinding: Implementation of Non-dominated Sorting Genetic Algorithm (NSGA-III) in Healthcare]]>https://eurekaselect.com/article/1380342024-03-28Background: Medical imaging plays a key role in neurosurgery; thereby, imaging and analysis of the soft and hard tissues during bone grinding is of paramount importance for neurosurgeons. Bone grinding, a minimally invasive operation in the field of neurosurgery amid osteotomy, has been used during brain cancer surgery.

Aims and Objectives: With increasing attention to neural tissue damage in machining operations, imaging of these neural tissues becomes vital and reducing temperature is imperative.

Methods: In the present study, a novel attempt has been made to perform the imaging of bone tissues during the bone grinding procedure and further investigate the relationship between rotational speed, feed rate, depth of cut with cutting forces, and temperature. The role of cutting forces and temperature has been addressed as per the requirements of neurosurgeons. Firstly, a three-factor, three-level design was constructed with a full factorial design. Regression models were employed to construct the models between input parameters and response characteristics. Medical imaging techniques were used to perform a thorough analysis of thermal necrosis and damage to the bone. Subsequently, the non-dominated sorting genetic algorithm (NSGA-III) was used to optimize the parameters for reduction in the cutting forces and temperature during bone grinding while reducing neural tissue damage.

Results: The results revealed that the maximum value of tangential force was 21.32 N, thrust force was 9.25 N, grinding force ratio was 0.453, torque was 4.55 N-mm, and temperature was 59.3°C. It has been observed that maximum temperature was generated at a rotational speed of 55000 rpm, feed rate of 60 mm/min, and depth of cut of 1.0 mm. Histopathological imaging analysis revealed the presence of viable lacunas, empty lacunas, haversian canals, and osteocytes in the bone samples. Furthermore, the elemental composition of the bone highlights the presence of carbon (c) 59.49%, oxygen (O) 35.82%, sodium (Na) 0.11%, phosphorous 1.50%, sulphur 0.33%, chlorine 0.98%, and calcium 1.77%.

Conclusion: The study revealed that compared to the initial scenario, NSGA-III can produce better results without compromising the trial results. According to a statistical study, the rise in temperature during bone grinding was significantly influenced by rotating speed. The density of osteocytes in the lacunas was higher at lower temperatures. Furthermore, the results of surface electron microscopy and energy dispersive spectroscopy revealed the presence of bone over the surface of the grinding burr, which resulted in the loading of the grinding burr. The results of the present investigation will be beneficial for researchers and clinical practitioners worldwide.

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<![CDATA[Deep Learning Models for Coronary Atherosclerosis Detection in Coronary CT Angiography]]>https://eurekaselect.com/article/1283472024-03-28Background: Patients with atherosclerosis have a rather high risk of showing complications, if not diagnosed quickly and efficiently.

Objective: In this paper we aim to test and compare different pre-trained deep learning models, to find the best model for atherosclerosis detection in coronary CT angiography.

Methods: We experimented with different pre-trained deep learning models and fine-tuned each model to achieve the best classification accuracy. We then used the Haar wavelet decomposition to improve the model’s sensitivity.

Results: We found that the Resnet101 architecture had the best performance with an accuracy of 95.2%, 60.8% sensitivity, and 90.48% PPV. Compared to the state of the art which uses a 3D CNN and achieved 90.9% accuracy, 68.9% Sensitivity and 58.8% PPV, sensitivity was quite low. To improve the sensitivity, we chose to use the Haar wavelet decomposition and trained the CNN model with the module of the three details: Low_High, High_Low, and High_High. The best sensitivity reached 80% with the CNN_KNN classifier.

Conclusion: It is possible to perform atherosclerosis detection straight from CCTA images using a pretrained Resnet101, which has good accuracy and PPV. The low sensitivity can be improved using Haar wavelet decomposition and CNN-KNN classifier.

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<![CDATA[How to Collect and Interpret Medical Pictures Captured in Highly Challenging Environments that Range from Nanoscale to Hyperspectral Imaging]]>https://eurekaselect.com/article/1284842024-03-28 <![CDATA[Zinner Syndrome: Radiologic Diagnosis in a Rare Case]]>https://eurekaselect.com/article/1341262024-03-28Background: Zinner’s syndrome is a rare congenital malformation of the seminal vesicle and ipsilateral upper urinary tract caused by mesonephric duct developmental anomaly during early embryogenesis. This study aimed to demonstrate the significance of magnetic resonance imaging (MRI) in distinguishing pelvic cysts in males, given that MRI is the gold standard exam for confirming the diagnosis and managing therapy.

Case Report: A 21-year-old male patient with a solitary kidney who had been diagnosed since birth presented with abdominal pain. Transabdominal and transrectal ultrasonography (US), computed tomography (CT), and MRI were performed. The contrast-enhanced MRI of the pelvis showed a tubular fluid-filled, macrolobulated lesion measuring 6 x 6 x 4 cm, mildly high signal intensity in the T2-weighted images, and slightly high signal intensity in the T1-weighted images, without contrast enhancement. The left kidney was hypoplasic. Imaging findings led to the diagnosis of Zinner’s syndrome, and conservative treatment was planned.

Discussion: Zinner’s syndrome is characterized by a triad consisting of unilateral renal agenesis or hypoplasia, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction. MRI is the modality of choice for an impeccable depiction of the anatomy of the male genital tract, for demonstrating the seminal vesicles and evaluating anomalies of the mesonephric duct. It is also useful in distinguishing seminal vesicle cysts from other cystic pelvic masses.

Conclusion: Zinner’s syndrome should be considered when diagnosing cystic pelvic masses in males with renal agenesis or hypoplasia. Because of its high soft tissue contrast resolution, MRI is the gold standard modality for confirming the diagnosis and assessing the cyst’s origin and contents.

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<![CDATA[Structured Reporting of Computed Tomography Enterography in Crohn’s Disease]]>https://eurekaselect.com/article/1371772024-03-28Background: To compare the integrity, clarity, conciseness, etc., of the structured report (SR) versus free-text report (FTR) for computed tomography enterography of Crohn’s disease (CD).

Methods: FTRs and SRs were generated for 30 patients with CD. The integrity, clarity, conciseness etc., of SRs versus FTRs, were compared. In this study, an evidence-based medicine practice model was utilized on 92 CD patients based on SR in order to evaluate its clinical value. Then, the life quality of the patients in two groups was evaluated before and after three months of intervention using an Inflammatory Bowel Disease Questionnaire (IBDQ).

Results: SRs received higher ratings for satisfaction with integrity (median rating 4.27 vs. 3.75, P=0.008), clarity (median rating 4.20 vs. 3.43, P=0.003), conciseness (median rating 4.23 vs. 3.20, P=0.003), the possibility of contacting a radiologist to interpret (median rating 4.17 vs. 3.20, P<0.001), and overall clinical impact (median rating 4.23 vs. 3.27, P<0.001) than FTRs. Besides, research group had higher score of IBDQ intestinal symptom dimension (median score 61.13 vs. 58.02, P=0.003), IBDQ systemic symptom dimension (median score 24.48 vs. 20.67, P<0.001), IBDQ emotional capacity dimension (median score 65.65 vs. 61.74, P<0.001), IBDQ social ability dimension (median score 26.80 vs. 22.37, P<0.001), and total IBDQ score (median score 178.07 vs. 162.80, P<0.001) than control group.

Conclusion: The SR of CTE in CD patients was conducive to improving the quality and readability of the report, and CD patients’ life quality could significantly improve after the intervention of an evidence-based medicine model based on SR.

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<![CDATA[Quantitative Comparison of Liver Volume, Proton Density Fat Fraction, and Time Burden between Automatic Whole Liver Segmentation and Manual Sampling MRI Strategies for Diagnosing Metabolic Dysfunction-associated Steatotic Liver Disease in Obese Patients]]>https://eurekaselect.com/article/1390102024-03-28Background: The performance of automatic liver segmentation and manual sampling MRI strategies needs be compared to determine interchangeability.

Objective: To compare automatic liver segmentation and manual sampling strategies (manual whole liver segmentation and standardized manual region of interest) for performance in quantifying liver volume and MRI-proton density fat fraction (MRI-PDFF), identifying steatosis grade, and time burden.

Methods: Fifty patients with obesity who underwent liver biopsy and MRI between December 2017 and November 2018 were included. Sampling strategies included automatic and manual whole liver segmentation and 4 and 9 large regions of interest. Intraclass correlation coefficient (ICC), Bland–Altman, linear regression, receiver operating characteristic curve, and Pearson correlation analyses were performed.

Results: Automatic whole liver segmentation liver volume and manual whole liver segmentation liver volume showed excellent agreement (ICC=0.97), high correlation (R2=0.96), and low bias (3.7%, 95% limits of agreement, -4.8%, 12.2%) in liver volume. There was the best agreement (ICC=0.99), highest correlation (R2=1.00), and minimum bias (0.84%, 95% limits of agreement, -0.20%, 1.89%) between automated whole liver segmentation MRI-PDFF and manual whole liver segmentation MRI-PDFF. There was no difference of each paired comparison of receiver operating characteristic curves for detecting steatosis (P=0.07–1.00). The minimum time burden for automatic whole liver segmentation was 0.32 s (0.32–0.33 s).

Conclusion: Automatic measurement has similar effects to manual measurement in quantifying liver volume, MRI-PDFF, and detecting steatosis. Time burden of automatic whole liver segmentation is minimal among all sampling strategies. Manual measurement can be replaced by automatic measurement to improve quantitative efficiency.

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<![CDATA[Fallopian Tube Leiomyoma Presenting as a Huge Abdominopelvic Cystic Mass: A Case Report and Literature Review]]>https://eurekaselect.com/article/1387842024-03-28Introduction: Fallopian tube leiomyoma is an uncommon, benign gynecologic tumor that originates from the smooth muscle of the fallopian tube or vascular cells supplying the fallopian tube.

Case Presentation: In this study, we report a case of a patient with fallopian tube leiomyoma. What makes this instance even more unique is the association of the leiomyoma with cystic degeneration, manifesting as a large abdominopelvic cystic mass. CT scan suspected that the mass might be an ovarian cystadenoma. However, ultrasonography, a widely used diagnostic tool, effectively assisted the clinicians in confidently ruling out the possibility that the tumor was originating from the ovaries. Ultimately, the patient underwent exploratory laparoscopy and the pathologic diagnosis was fallopian tube leiomyoma with cystic degeneration. To our knowledge, no instance of a fallopian tube leiomyoma of this size with cystic degeneration has been reported. Thus, it is worth mentioning.

Conclusion: In summary, fallopian tube leiomyomas are classified as uncommon benign gynecologic tumors, which pose challenges in clinical diagnosis. The combined use of multiple imaging modalities may be more helpful in the proper diagnosis of this disease entity.

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