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Wang H, Ma L. MCMC algorithm based on Markov random field in image segmentation. PLoS One 2024; 19:e0296031. [PMID: 38386655 PMCID: PMC10883568 DOI: 10.1371/journal.pone.0296031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/05/2023] [Indexed: 02/24/2024] Open
Abstract
In the realm of digital image applications, image processing technology occupies a pivotal position, with image segmentation serving as a foundational component. As the digital image application domain expands across industries, the conventional segmentation techniques increasingly challenge to cater to modern demands. To address this gap, this paper introduces an MCMC-based image segmentation algorithm based on the Markov Random Field (MRF) model, marking a significant stride in the field. The novelty of this research lies in its method that capitalizes on domain information in pixel space, amplifying the local segmentation precision of image segmentation algorithms. Further innovation is manifested in the development of an adaptive segmentation image denoising algorithm based on MCMC sampling. This algorithm not only elevates image segmentation outcomes, but also proficiently denoises the image. In the experimental results, MRF-MCMC achieves better segmentation performance, with an average segmentation accuracy of 94.26% in Lena images, significantly superior to other common image segmentation algorithms. In addition, the study proposes that the denoising model outperforms other algorithms in peak signal-to-noise ratio and structural similarity in environments with noise standard deviations of 15, 25, and 50. In essence, these experimental findings affirm the efficacy of this study, opening avenues for refining digital image segmentation methodologies.
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Affiliation(s)
- Huazhe Wang
- College of Computer Engineering, Shangqiu Polytechnic, Shangqiu, China
| | - Li Ma
- Soft Vocational Technology Institute, Shangqiu Polytechnic, Shangqiu, China
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Moramarco L, Grande AM, Vertemati M, Aseni P. Prostate Artery Embolization in the Treatment of Massive Intractable Bleeding from Prostatic Neoplasms: A Case Report and Systematic Review. J Clin Med 2023; 13:65. [PMID: 38202072 PMCID: PMC10780233 DOI: 10.3390/jcm13010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Lower urinary tract symptoms (LUTS) and hematuria are common symptoms in men with neoplasms, mainly affecting the elderly population. Prostatic arterial embolization (PAE) is a minimally invasive procedure that has shown promising results in managing LUTS and massive intractable prostatic hematuria in patients with benign prostatic hyperplasia (BPH) and prostate cancer (PCa). A few studies, however, have provided valuable insights into the durability and efficacy of PAE focusing on the long-term effectiveness, quality of life, and cancer-specific control of hemostasis and urinary symptoms. As a result of concomitant cardiovascular conditions, these patients often take anticoagulants or antithrombotics, which can worsen their hematuria and clinical status. Transurethral resection of the prostate (TURP) is considered a very high-risk procedure, even without massive bleeding, and requires discontinuation of vitamin K antagonists and antiplatelet therapies. Such patients usually have their surgery postponed, and PAE should be considered a safe alternative treatment. We aimed to report a narrative review from 1976 to June 2023 of the current state of PAE for massive and intractable hematuria, highlighting recent developments in this technique, including prospective cohort studies, and focusing on long-term outcome, safety, and complication management of patients with prostatic neoplasms who develop significant hemorrhagic symptoms. Additionally, we present a case report and a simple algorithm for treating intractable bleeding in a 92-year-old man with PCa and massive hematuria.
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Affiliation(s)
- Lorenzo Moramarco
- Radiologia—Neuroradiologia Diagnostica ed Interventistica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Antonino M. Grande
- Divisione Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Paolo Aseni
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
- Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda Hospital, 20162 Milan, Italy
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Wu X, Zhou A, Heller M, Chi T, Kohlbrenner R. Comparison of Minimally Invasive Procedures for Benign Prostatic Hyperplasia: A Cost-effectiveness Analysis. Radiology 2023; 309:e230555. [PMID: 38085076 DOI: 10.1148/radiol.230555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Benign prostatic hyperplasia (BPH) is a disease that affects millions of U.S. men and is costly to treat. Purpose To compare the cost-effectiveness of four minimally invasive therapies (MITs) and medical management for the treatment of BPH. Materials and Methods A cost-effectiveness analysis from a payer's perspective with Markov modeling was performed, comparing prostatic artery embolization (PAE), prostatic urethral lift, aquablation, water vapor thermal therapy, and medical management for BPH spanning a time horizon of 5 years. The model incorporated the probability of procedural complications and recurrent symptoms necessitating retreatment, which were extracted from published studies with long-term follow-up. Costs were based on Medicare reimbursements using CPT codes for ambulatory surgery centers. Outcomes were measured using the quality-adjusted life year (QALY), incorporating both life quality and expectancy. Statistical analyses included a base case calculation (using the most probable value of each parameter) and probabilistic and deterministic sensitivity analyses. Results In the base case calculation, outcomes for the strategies were comparable, with a difference of 0.030 QALY (11 days of life in perfect health) between the most (PAE) and least (medical management) effective strategies. PAE was the most cost-effective strategy relative to medical management, with an incremental cost-effectiveness ratio of $64 842 per QALY. Probabilistic sensitivity analysis showed PAE was more cost-effective compared with prostatic urethral lift, aquablation, water vapor therapy, and medical management in pairwise comparisons. In sensitivity analysis of retreatment risk, PAE remained the most cost-effective strategy until its repeat treatment rates exceeded 2.30% per 6 months, at which point water vapor therapy became the optimal choice. PAE was the most cost-effective procedure when its procedural cost was lower than $4755. Aquablation and prostatic urethral lift became more cost-effective when their procedural costs were lower than $3015 and $1097, respectively. Conclusion This modeling-based study showed that PAE appears to be a cost-effective modality among medical management and MITs for patients with BPH, with comparable outcomes to prostatic urethral lift, water vapor therapy, and aquablation at a lower expected cost. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Gemmete in this issue.
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Affiliation(s)
- Xiao Wu
- From the Department of Radiology and Biomedical Imaging (X.W., A.Z., M.H., R.K.) and Department of Urology (T.C.), University of California-San Francisco, 505 Parnassus Ave, San Francisco, CA 94143
| | - Alice Zhou
- From the Department of Radiology and Biomedical Imaging (X.W., A.Z., M.H., R.K.) and Department of Urology (T.C.), University of California-San Francisco, 505 Parnassus Ave, San Francisco, CA 94143
| | - Michael Heller
- From the Department of Radiology and Biomedical Imaging (X.W., A.Z., M.H., R.K.) and Department of Urology (T.C.), University of California-San Francisco, 505 Parnassus Ave, San Francisco, CA 94143
| | - Thomas Chi
- From the Department of Radiology and Biomedical Imaging (X.W., A.Z., M.H., R.K.) and Department of Urology (T.C.), University of California-San Francisco, 505 Parnassus Ave, San Francisco, CA 94143
| | - Ryan Kohlbrenner
- From the Department of Radiology and Biomedical Imaging (X.W., A.Z., M.H., R.K.) and Department of Urology (T.C.), University of California-San Francisco, 505 Parnassus Ave, San Francisco, CA 94143
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Young S. Cost Matters: A Rigorous Economic Analysis of PAE with Comparison to TURP. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03487-x. [PMID: 37369822 DOI: 10.1007/s00270-023-03487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Shamar Young
- Division of Interventional Radiology, Department of Medical Imaging, University of Arizona, 1501 N Campbell Ave, Tucson, AZ, 85724, USA.
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Capdevila F, Insausti I, San Miguel R, Sanchez-Iriso E, Montesino M. Cost-Utility Analysis of Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03443-9. [PMID: 37142802 DOI: 10.1007/s00270-023-03443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/05/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To perform a post hoc cost-utility analysis of a randomized controlled clinical trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP) in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS We conducted a cost-utility analysis over a 5-year period to compare PAE versus TURP from a Spanish National Health System perspective. Data were collected from a randomized clinical trial performed at a single institution. Effectiveness was measured as quality-adjusted life years (QALYs), and an incremental cost-effectiveness ratio (ICER) was derived from the cost and QALY values associated with these treatments. Further sensitivity analysis was performed to account for the impact of reintervention on the cost-effectiveness of both procedures. RESULTS At the 1-year follow-up, PAE resulted in mean cost per patient of €2904.68 and outcome of 0.975 QALYs per treatment. In comparison, TURP had cost €3846.72 per patient and its outcome was 0.953 QALYs per treatment. At 5 years, the cost for PAE and TURP were €4117.13 and €4297.58, and the mean QALY outcome was 4.572 and 4.487, respectively. Analysis revealed an ICER of €2121.15 saved per QALY gained when comparing PAE to TURP at long-term follow-up. Reintervention rate for PAE and TURP was 12% and 0%, respectively. CONCLUSIONS Compared to TURP, in short term, PAE could be considered a cost-effective strategy within the Spanish healthcare system for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. However, in long term, the superiority is less apparent due to higher reintervention rates.
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Affiliation(s)
- Ferran Capdevila
- Department of Pharmacy, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain.
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain.
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain.
| | - Iñigo Insausti
- Department of Radiology, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Ramon San Miguel
- Department of Pharmacy, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Eduardo Sanchez-Iriso
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Manuel Montesino
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
- Department of Urology, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
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Bilhim T. Prostatic Artery Embolization: An Update. Korean J Radiol 2023; 24:313-323. [PMID: 36788767 PMCID: PMC10067687 DOI: 10.3348/kjr.2022.0814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Tiago Bilhim
- Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal.,Department of Interventional Radiology, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal.
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Qamhawi Z, Little MW. The State of Evidence in Prostate Artery Embolization. Semin Intervent Radiol 2022; 39:571-576. [PMID: 36561795 PMCID: PMC9767761 DOI: 10.1055/s-0042-1759733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prostate artery embolization (PAE) has emerged over the past two decades as a minimally invasive, nonsurgical treatment for benign prostatic hypertrophy (BPH). While the majority of evidence for PAE stems from retrospective cohort studies, several seminal randomized controlled trials have been performed comparing short-term outcomes of PAE to transurethral resection of prostate (TURP) and against a sham procedure. Across clinical trials, PAE demonstrates consistent improvement in urological symptoms and quality of life in patients with BPH with low complication rates. When compared to TURP, the results are comparable, but there is a trend for better outcomes in certain clinical parameters with TURP. PAE is a suitable option for patients who are not surgical candidates, prefer nonsurgical treatment with an earlier return to routine activities, and wish to better preserve sexual function.
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Affiliation(s)
- Zahi Qamhawi
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Mark W. Little
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
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Bilhim T. Long-Term PAE Results: What Do We Know. Semin Intervent Radiol 2022; 39:577-580. [PMID: 36561801 PMCID: PMC9767787 DOI: 10.1055/s-0042-1759732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prostatic artery embolization (PAE) is a minimally invasive technique with proven safety and efficacy to treat lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) or benign prostatic hyperplasia (BPH). In this review, we discuss the required level of evidence to implement and adopt treatment options for patients with LUTS due to BPO/BPH. Focus is given on the long-term (>3 years) data after PAE with reported outcomes including cohort sizes, follow-up times, reintervention rates (repeat PAE and prostatectomy), need for LUTS/BPO medical therapy, and improvements in International Prostate Symptom Score/quality of life score, peak flow rate (Qmax), postvoid residual, prostate volume, and prostate-specific antigen. The durability of treatment effects after PAE and need for prostatic reinterventions need to be taken into consideration when discussing treatment options with patients and referring colleagues from other medical specialties. Developments in medical devices used for PAE have allowed for a continuous drop in unilateral PAE rates over the last 12 years and will probably play a role in optimizing technical and thus clinical outcomes for patients with LUTS due to BPH/BPO.
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Affiliation(s)
- Tiago Bilhim
- Saint Louis Hospital, Centro Hospitalar Universitário de Lisboa Central (CHULC) Lisbon, Portugal
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Bulman JC, Sarwar A. Prostate Artery Embolization Versus Transurethral Resection of the Prostate: Is Cost-Effectiveness Analyses Useful to Improve Access to Image-Guided Procedures in the United States? J Am Coll Radiol 2022; 19:744-745. [PMID: 35550882 DOI: 10.1016/j.jacr.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/22/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Julie C Bulman
- Department of Radiology, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Ammar Sarwar
- Department of Radiology, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
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