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Sunnetci KM, Kaba E, Celiker FB, Alkan A. MR Image Fusion-Based Parotid Gland Tumor Detection. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01137-3. [PMID: 39327379 DOI: 10.1007/s10278-024-01137-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 09/28/2024]
Abstract
The differentiation of benign and malignant parotid gland tumors is of major significance as it directly affects the treatment process. In addition, it is also a vital task in terms of early and accurate diagnosis of parotid gland tumors and the determination of treatment planning accordingly. As in other diseases, the differentiation of tumor types involves several challenging, time-consuming, and laborious processes. In the study, Magnetic Resonance (MR) images of 114 patients with parotid gland tumors are used for training and testing purposes by Image Fusion (IF). After the Apparent Diffusion Coefficient (ADC), Contrast-enhanced T1-w (T1C-w), and T2-w sequences are cropped, IF (ADC, T1C-w), IF (ADC, T2-w), IF (T1C-w, T2-w), and IF (ADC, T1C-w, T2-w) datasets are obtained for different combinations of these sequences using a two-dimensional Discrete Wavelet Transform (DWT)-based fusion technique. For each of these four datasets, ResNet18, GoogLeNet, and DenseNet-201 architectures are trained separately, and thus, 12 models are obtained in the study. A Graphical User Interface (GUI) application that contains the most successful of these trained architectures for each data is also designed to support the users. The designed GUI application not only allows the fusing of different sequence images but also predicts whether the label of the fused image is benign or malignant. The results show that the DenseNet-201 models for IF (ADC, T1C-w), IF (ADC, T2-w), and IF (ADC, T1C-w, T2-w) are better than the others, with accuracies of 95.45%, 95.96%, and 92.93%, respectively. It is also noted in the study that the most successful model for IF (T1C-w, T2-w) is ResNet18, and its accuracy is equal to 94.95%.
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Affiliation(s)
- Kubilay Muhammed Sunnetci
- Department of Electrical and Electronics Engineering, Osmaniye Korkut Ata University, Osmaniye, 80000, Turkey
- Department of Electrical and Electronics Engineering, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, 46050, Turkey
| | - Esat Kaba
- Department of Radiology, Recep Tayyip Erdogan University, Rize, 53100, Turkey
| | | | - Ahmet Alkan
- Department of Electrical and Electronics Engineering, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, 46050, Turkey.
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Liu Z, Wen B, Zhang Z, Qu F, Wu Y, Grimm R, Zhang Y, Cheng J, Zhang Y. The value of diffusion kurtosis imaging and dynamic contrast-enhanced magnetic resonance imaging in the differential diagnosis of parotid gland tumors. Gland Surg 2024; 13:1254-1268. [PMID: 39175702 PMCID: PMC11336784 DOI: 10.21037/gs-24-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/10/2024] [Indexed: 08/24/2024]
Abstract
Background Parotid gland tumors (PGTs) are the most common benign tumors of salivary gland tumors. However, the diagnostic value of relative values of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion kurtosis imaging (DKI) parameters for PGTs has not been extensively studied. Therefore, this study aimed to evaluate the diagnostic performance of combined DKI and DCE-MRI for differentiating PGTs by introducing the concept of relative value. Methods The DCE-MRI and DKI imaging data of 142 patients with PGTs between June 2018 and August 2022 were collected. Patients were divided into four groups by histopathology: malignant tumors (MTs), pleomorphic adenomas (PAs), Warthin tumors (WTs), and basal cell adenomas (BCAs). All MRI examinations were conducted using a 3 T MRI scanner with a 20-channel head and neck coil. Quantitative parameters of DCE-MRI and DKI and their relative values were determined. Kruskal-Wallis H test, post-hoc test with Bonferroni correction, one-way analysis of variance (ANOVA) and post-hoc test with least significant difference (LSD) method, and the receiver operating characteristic (ROC) curve were used for statistical analysis. Statistical significance was set at P<0.05. Results Only the combination of DKI and DCE-MRI parameters could reliably distinguish BCAs from other PGTs. PAs demonstrated the lowest transfer constant from plasma to extravascular extracellular space (Ktrans) value [0.09 (0.06, 0.20) min-1], relative Ktrans (rKtrans) [-0.24 (-0.64, 1.00)], rate constant from extravascular extracellular space to plasma (Kep) value [0.32 (0.22, 0.53) min-1], relative Kep (rKep) [0.32 (0.22, 0.53) min-1], and initial area under curve (iAUC) value [0.15 (0.09, 0.26) mmol·s/kg] compared with WTs, BCAs, and MTs (all P<0.05). The Ktrans values for MTs were substantially lower [0.17 (0.10, 0.31) min-1] than those for WTs (P=0.01). The Kep values for MTs [0.71 (0.52, 1.28) min-1] were substantially lower (all P<0.05) than those for WTs and BCAs. PAs and BCAs had higher diffusion coefficient (D) values and lower diffusion kurtosis (K) values and relative K (rK) values than MTs and WTs. However, the D and K values did not differ significantly even in their relative values of PAs and BCAs (all P>0.05). By using logistic regression, the combination of K value and rKep value further enhanced their discriminatory power between PAs and WTs [area under the ROC curve (AUC), 0.986], the combination of K and rKep value further enhanced their discriminatory power between PAs and MTs (AUC, 0.915), and the combination of D and Kep value further enhanced their discriminatory power between BCAs and MTs (AUC, 0.909). Conclusions DKI and DCE-MRI can be used to differentiate PGTs quantitatively and can complement each other. The combined use of DKI and DCE-MRI parameters can improve the diagnostic accuracy of distinguishing PGTs.
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Affiliation(s)
- Zijun Liu
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Baohong Wen
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zanxia Zhang
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feifei Qu
- MR Collaboration, Siemens Healthineer Ltd., Shanghai, China
| | - Yanglei Wu
- MR Collaboration, Siemens Healthineer Ltd., Beijing, China
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Zhang
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Mao Y, Jiang LP, Wang JL, Diao YH, Chen FQ, Zhang WP, Chen L, Liu ZX. Multi-feature Fusion Network on Gray Scale Ultrasonography: Effective Differentiation of Adenolymphoma and Pleomorphic Adenoma. Acad Radiol 2024:S1076-6332(24)00308-8. [PMID: 38871552 DOI: 10.1016/j.acra.2024.05.023] [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: 04/02/2024] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024]
Abstract
RATIONALE AND OBJECTIVES to develop a deep learning radiomics graph network (DLRN) that integrates deep learning features extracted from gray scale ultrasonography, radiomics features and clinical features, for distinguishing parotid pleomorphic adenoma (PA) from adenolymphoma (AL) MATERIALS AND METHODS: A total of 287 patients (162 in training cohort, 70 in internal validation cohort and 55 in external validation cohort) from two centers with histologically confirmed PA or AL were enrolled. Deep transfer learning features and radiomics features extracted from gray scale ultrasound images were input to machine learning classifiers including logistic regression (LR), support vector machines (SVM), KNN, RandomForest (RF), ExtraTrees, XGBoost, LightGBM, and MLP to construct deep transfer learning radiomics (DTL) models and Rad models respectively. Deep learning radiomics (DLR) models were constructed by integrating the two features and DLR signatures were generated. Clinical features were further combined with the signatures to develop a DLRN model. The performance of these models was evaluated using receiver operating characteristic (ROC) curve analysis, calibration, decision curve analysis (DCA), and the Hosmer-Lemeshow test. RESULTS In the internal validation cohort and external validation cohort, comparing to Clinic (AUC=0.767 and 0.777), Rad (AUC=0.841 and 0.748), DTL (AUC=0.740 and 0.825) and DLR (AUC=0.863 and 0.859), the DLRN model showed greatest discriminatory ability (AUC=0.908 and 0.908) showed optimal discriminatory ability. CONCLUSION The DLRN model built based on gray scale ultrasonography significantly improved the diagnostic performance for benign salivary gland tumors. It can provide clinicians with a non-invasive and accurate diagnostic approach, which holds important clinical significance and value. Ensemble of multiple models helped alleviate overfitting on the small dataset compared to using Resnet50 alone.
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Affiliation(s)
- Yi Mao
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Li-Ping Jiang
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Jing-Ling Wang
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Yu-Hong Diao
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Fang-Qun Chen
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Wei-Ping Zhang
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Li Chen
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Zhi-Xing Liu
- Department of Ultrasonography, The First Affiliated Hospital of Nanchang University, Nanchang, China; Department of Ultrasonography, GanJiang New District Peoples Hospital, Nanchang, China.
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Kouka M, Waldner M, Guntinas-Lichius O. Multispectral optoacoustic tomography of benign parotid tumors in vivo: a prospective observational pilot study. Sci Rep 2024; 14:10597. [PMID: 38719924 PMCID: PMC11079028 DOI: 10.1038/s41598-024-61303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
Parotid lumps are a heterogeneous group of mainly benign but also malignant tumors. Preoperative imaging does not allow a differentiation between tumor types. Multispectral optoacoustic tomography (MSOT) may improve the preoperative diagnostics. In this first prospective pilot trial the ability of MSOT to discriminate between the two most frequent benign parotid tumors, pleomorphic adenoma (PA) and Warthin tumor (WT) as well as to normal parotid tissue was explored. Six wavelengths (700, 730, 760, 800, 850, 900 nm) and the parameters deoxygenated (HbR), oxygenated (HbO2), total hemoglobin (HbT), and saturation of hemoglobin (sO2) were analyzed. Ten patients with PA and fourteen with WT were included (12/12 female/male; median age: 51 years). For PA, the mean values for all measured wave lengths as well as for the hemoglobin parameters were different for the tumors compared to the healthy parotid (all p < 0.05). The mean MSOT parameters were all significantly higher (all p < 0.05) in the WT compared to healthy parotid gland except for HbT and sO2. Comparing both tumors directly, the mean values of MSOT parameters were not different between PA and WT (all p > 0.05). Differences were seen for the maximal MSOT parameters. The maximal tumor values for 900 nm, HbR, HbT, and sO2 were lower in PA than in WT (all p < 0.05). This preliminary MSOT parotid tumor imaging study showed clear differences for PA or WT compared to healthy parotid tissue. Some MSOT characteristics of PA and WT were different but needed to be explored in larger studies.
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Affiliation(s)
- Mussab Kouka
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Maximilian Waldner
- Department of Medicine, University of Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Lin W, Ye W, Ma J, Wang S, Chen P, Yang Y, Yin B. Differentiation of parotid pleomorphic adenoma from Warthin tumor using signal intensity ratios on fat-suppressed T2-weighted magnetic resonance imaging. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:310-319. [PMID: 38195353 DOI: 10.1016/j.oooo.2023.12.786] [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: 07/20/2023] [Revised: 11/28/2023] [Accepted: 12/09/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To investigate the value of magnetic resonance imaging (MRI) signal intensity ratios (SIRs) based on fat-suppressed T2-weighted imaging (FS-T2WI), together with demographic features, MRI anatomical characteristics, and SIRs of histopathological patterns of the tumors, in the differentiation of parotid pleomorphic adenoma (PA) from Warthin tumor (WT). STUDY DESIGN In total, 90 patients with PA and 56 patients with WT were enrolled in the study. SIRs of tumor to normal parotid gland (SIR-T/P), spinal cord (SIR-T/S), and muscle (SIR-T/M) were calculated. Demographic and radiological features of the 2-patient groups were compared with univariate analysis and multivariate logistic regression analysis. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were analyzed to evaluate the utility of SIRs in distinguishing between PA and WT. RESULTS SIR-T/P exhibited outstanding discriminating ability (AUC = 0.934), SIR-T/S had excellent discrimination (AUC = 0.839), and SIR-T/M showed acceptable discrimination (AUC = 0.728). When SIR-T/P of 1.96 was selected as the cutoff value, sensitivity and specificity were 0.756 and 0.982, respectively. SIR-T/P, age, sex, and number of lesions were identified as independent predictors by multivariate logistic regression analysis. Differences in SIRs between histopathological patterns were significant. CONCLUSION SIR-T/P based on FS-T2WI is an effective discriminator in the differential diagnosis between PA and WT. Age, sex, and number of lesions provided additional value in differentiation.
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Affiliation(s)
- Wenqing Lin
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Weihu Ye
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Jingzhi Ma
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Shiwen Wang
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Pan Chen
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Yan Yang
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China; School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.
| | - Bing Yin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.
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Sunnetci KM, Kaba E, Celiker FB, Alkan A. Deep Network-Based Comprehensive Parotid Gland Tumor Detection. Acad Radiol 2024; 31:157-167. [PMID: 37271636 DOI: 10.1016/j.acra.2023.04.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 06/06/2023]
Abstract
RATIONALE AND OBJECTIVES Salivary gland tumors constitute 2%-6% of all head and neck tumors and are most common in the parotid gland. Magnetic resonance (MR) imaging is the most sensitive imaging modality for diagnosis. Tumor type, localization, and relationship with surrounding structures are important factors for treatment. Therefore, parotid gland tumor segmentation is important. Specialists widely use manual segmentation in diagnosis and treatment. However, considering the development of artificial intelligence-based models today, it is seen that artificial intelligence-based automatic segmentation models can be used instead of manual segmentation, which is a time-consuming technique. Therefore, we segmented parotid gland tumor (PGT) using deep learning-based architectures in the paper. MATERIALS AND METHODS The dataset used in the study includes 102 T1-w, 102 contrast-enhanced T1-w (T1C-w), and 102 T2-w MR images. After cropping the raw and manually segmented images by experts, we obtained the masks of these images. After standardizing the image sizes, we split these images into approximately 80% training set and 20% test set. Hereabouts, we trained six models for these images using ResNet18 and Xception-based DeepLab v3+. We prepared a user-friendly Graphical User Interface application that includes each of these models. RESULTS From the results, the accuracy and weighted Intersection over Union values of the ResNet18-based DeepLab v3+ architecture trained for T1C-w, which is the most successful model in the study, are equal to 0.96153 and 0.92601, respectively. Regarding the results and the literature, it can be seen that the proposed system is competitive in terms of both using MR images and training the models independently for T1-w, T1C-w, and T2-w. Expressing that PGT is usually segmented manually in the literature, we predict that our study can contribute significantly to the literature. CONCLUSION In this study, we prepared and presented a software application that can be easily used by users for automatic PGT segmentation. In addition to predicting the reduction of costs and workload through the study, we developed models with meaningful performance metrics according to the literature.
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Affiliation(s)
- Kubilay Muhammed Sunnetci
- Osmaniye Korkut Ata University, Department of Electrical and Electronics Engineering, Osmaniye 80000, Turkey (K.M.S.); Kahramanmaraş Sütçü İmam University, Department of Electrical and Electronics Engineering, Kahramanmaraş 46050, Turkey (K.M.S., A.A.).
| | - Esat Kaba
- Recep Tayyip Erdogan University, Department of Radiology, Rize, Turkey (E.K., F.B.C.)
| | - Fatma Beyazal Celiker
- Recep Tayyip Erdogan University, Department of Radiology, Rize, Turkey (E.K., F.B.C.)
| | - Ahmet Alkan
- Kahramanmaraş Sütçü İmam University, Department of Electrical and Electronics Engineering, Kahramanmaraş 46050, Turkey (K.M.S., A.A.)
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Muntean DD, Dudea SM, Băciuț M, Dinu C, Stoia S, Solomon C, Csaba C, Rusu GM, Lenghel LM. The Role of an MRI-Based Radiomic Signature in Predicting Malignancy of Parotid Gland Tumors. Cancers (Basel) 2023; 15:3319. [PMID: 37444429 PMCID: PMC10340186 DOI: 10.3390/cancers15133319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/11/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
The aim of this study was to assess the ability of MRI radiomic features to differentiate between benign parotid gland tumors (BPGT) and malignant parotid gland tumors (MPGT). This retrospective study included 93 patients who underwent MRI examinations of the head and neck region (78 patients presenting unique PGT, while 15 patients presented double PGT). A total of 108 PGT with histological confirmation were eligible for the radiomic analysis and were assigned to a training group (n = 83; 58 BPGT; 25 MPGT) and a testing group (n = 25; 16 BPGT; 9 MPGT). The radiomic features were extracted from 3D segmentations of the PGT on the T2-weighted and fat-saturated, contrast-enhanced T1-weighted images. Following feature reduction techniques, including LASSO regression analysis, a radiomic signature (RS) was built with five radiomic features. The RS presented a good diagnostic performance in differentiating between PGT, achieving an area under the curve (AUC) of 0.852 (p < 0.001) in the training set and 0.786 (p = 0.017) in the testing set. In both datasets, the RS proved to have lower values in the BPGT group as compared to MPGT group (p < 0.001 and p = 0.023, respectively). The multivariate analysis revealed that RS was independently associated with PGT malignancy, together with the ill-defined margin pattern (p = 0.031, p = 0.001, respectively). The complex model, using clinical data, MRI features and the RS, presented a higher diagnostic performance (AUC of 0.976) in comparison to the RS alone. MRI-based radiomic features could be considered potential additional imaging biomarkers able to discriminate between benign and malignant parotid gland tumors.
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Affiliation(s)
- Delia Doris Muntean
- Department of Radiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.D.M.); (S.M.D.); (C.C.); (G.M.R.); (L.M.L.)
| | - Sorin Marian Dudea
- Department of Radiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.D.M.); (S.M.D.); (C.C.); (G.M.R.); (L.M.L.)
| | - Mihaela Băciuț
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.B.); (C.D.); (S.S.)
| | - Cristian Dinu
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.B.); (C.D.); (S.S.)
| | - Sebastian Stoia
- Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.B.); (C.D.); (S.S.)
| | - Carolina Solomon
- Department of Radiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.D.M.); (S.M.D.); (C.C.); (G.M.R.); (L.M.L.)
| | - Csutak Csaba
- Department of Radiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.D.M.); (S.M.D.); (C.C.); (G.M.R.); (L.M.L.)
| | - Georgeta Mihaela Rusu
- Department of Radiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.D.M.); (S.M.D.); (C.C.); (G.M.R.); (L.M.L.)
| | - Lavinia Manuela Lenghel
- Department of Radiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (D.D.M.); (S.M.D.); (C.C.); (G.M.R.); (L.M.L.)
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