1
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Strahnen D, Stathi A, Beck J, Roelz R, Vasilikos I. Case report: Concurrent low-volume subdural hematoma and ipsilateral ischemic stroke presenting as capsular warning syndrome: a complex case with anticoagulation dilemma and dual pathology. Front Neurol 2024; 15:1358237. [PMID: 38445261 PMCID: PMC10912296 DOI: 10.3389/fneur.2024.1358237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/06/2024] [Indexed: 03/07/2024] Open
Abstract
Background The simultaneous emergence of low-volume subdural hematoma and ipsilateral ischemic stroke in an atrial fibrillation patient who is under anticoagulation therapy is a rare and intricate clinical case. This report accentuates the diagnostic and treatment complexities associated with these consecutive neurological conditions. Case presentation An 83 years-old male patient initially presented with acute dyspnea, raising the suspicion of pulmonary embolism. After exclusion of pulmonary embolism through CT angiography, the patient experienced a sudden onset of left-sided hemiparesis without prior history of head trauma but with chronic intake of apixaban due to atrial fibrillation. Subsequent cranial CT tomography revealed a small right parietal subdural hematoma. After reversal of the anticoagulation therapy, surgical evacuation of the subdural hematoma was successfully performed. However, in the postoperative period, the patient developed new neurological symptoms that could not be explained by the reduced size of the subdural hematoma on a follow-up CT scan. Cranial MRI revealed the coexistence of acute ischemic stroke in the right corona radiata. The recent surgical procedure precluded guideline-recommended stroke treatment. Discussion This case underscores the complexities of diagnosing and treating concomitant small volume subdural hematoma and ischemic stroke, especially if the latter occurs in the corona radiata resulting in fluctuating symptoms known as "capsular warning syndrome." Reversal and secondary discontinuation of anticoagulant therapy for surgical intervention highlight the inherent risk of thrombotic events in anticoagulated patients. The development of tailored treatment strategies requires a multidisciplinary approach, and further research and guidelines are required in similar complex scenarios. Conclusion The presence of both a small subdural hematoma and an ipsilateral ischemic stroke presenting as capsular warning syndrome in an anticoagulated patient highlights the intricacy of their care. This case calls for a comprehensive and collaborative strategy to address complicated clinical scenarios.
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Affiliation(s)
- Daniel Strahnen
- Department of Neurosurgery, University Medical Center Freiburg, Freiburg, Germany
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2
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van Doesburg JR, Voeten DM, Kalff MC, van Berge Henegouwen MI, Jol S, van den Bergh JE, Engelsman AF, Gisbertz SS, Daams F. Incidence and oncological implication of adrenal incidentalomas in esophageal cancer patients. Dis Esophagus 2023; 36:doad003. [PMID: 36722353 PMCID: PMC10473449 DOI: 10.1093/dote/doad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/15/2022] [Accepted: 01/01/2023] [Indexed: 02/02/2023]
Abstract
Adrenal incidentalomas are regularly encountered during imaging for esophageal cancer patients, but their oncological significance remains unknown. This study aimed to describe the incidence and etiology of adrenal incidentalomas observed throughout the diagnostic workup. This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2012 and December 2016. Radiology and multidisciplinary team meeting reports were reviewed for adrenal incidentalomas. In case of adrenal incidentaloma, the 18FDG-PET/CT was reassessed by a radiologist blinded for the original report. In case of a metachronous incidentaloma during follow-up, visibility on previous imaging was reassessed. Primary outcome was the incidence, etiology and oncological consequence of synchronous adrenal incidentalomas. This study included 1,164 esophageal cancer patients, with a median age of 66 years. Patients were predominantly male (76.1%) and the majority had an adenocarcinoma (69.0%). Adrenal incidentalomas were documented in 138 patients (11.9%) during the diagnostic workup. At primary esophageal cancer workup, 22 incidentalomas proved malignant. However, follow-up showed that four incidentalomas were inaccurately diagnosed as benign and three malignant incidentalomas were visible on staging imaging but initially missed. Stage migration occurred in 15 of 22 (68.2%), but this would have been higher if none were missed or inaccurately diagnosed. The oncological impact of adrenal incidentalomas in patients with esophageal cancer is significant as a considerable part of incidentalomas changed treatment intent from curative to palliative. As stage migration is likely, pathological examination of a synchronous adrenal incidentaloma should be weighted in mind.
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Affiliation(s)
- J R van Doesburg
- Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - D M Voeten
- Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - M C Kalff
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - M I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S Jol
- Department of Radiology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
| | - J E van den Bergh
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
| | - A F Engelsman
- Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - F Daams
- Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
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3
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Szmul A, Taylor S, Lim P, Cantwell J, Moreira I, Zhang Y, D’Souza D, Moinuddin S, Gaze MN, Gains J, Veiga C. Deep learning based synthetic CT from cone beam CT generation for abdominal paediatric radiotherapy. Phys Med Biol 2023; 68:105006. [PMID: 36996837 PMCID: PMC10160738 DOI: 10.1088/1361-6560/acc921] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/13/2023] [Accepted: 03/30/2023] [Indexed: 04/01/2023]
Abstract
Objective. Adaptive radiotherapy workflows require images with the quality of computed tomography (CT) for re-calculation and re-optimisation of radiation doses. In this work we aim to improve the quality of on-board cone beam CT (CBCT) images for dose calculation using deep learning.Approach. We propose a novel framework for CBCT-to-CT synthesis using cycle-consistent Generative Adversarial Networks (cycleGANs). The framework was tailored for paediatric abdominal patients, a challenging application due to the inter-fractional variability in bowel filling and small patient numbers. We introduced to the networks the concept of global residuals only learning and modified the cycleGAN loss function to explicitly promote structural consistency between source and synthetic images. Finally, to compensate for the anatomical variability and address the difficulties in collecting large datasets in the paediatric population, we applied a smart 2D slice selection based on the common field-of-view (abdomen) to our imaging dataset. This acted as a weakly paired data approach that allowed us to take advantage of scans from patients treated for a variety of malignancies (thoracic-abdominal-pelvic) for training purposes. We first optimised the proposed framework and benchmarked its performance on a development dataset. Later, a comprehensive quantitative evaluation was performed on an unseen dataset, which included calculating global image similarity metrics, segmentation-based measures and proton therapy-specific metrics.Main results. We found improved performance for our proposed method, compared to a baseline cycleGAN implementation, on image-similarity metrics such as Mean Absolute Error calculated for a matched virtual CT (55.0 ± 16.6 HU proposed versus 58.9 ± 16.8 HU baseline). There was also a higher level of structural agreement for gastrointestinal gas between source and synthetic images measured using the dice similarity coefficient (0.872 ± 0.053 proposed versus 0.846 ± 0.052 baseline). Differences found in water-equivalent thickness metrics were also smaller for our method (3.3 ± 2.4% proposed versus 3.7 ± 2.8% baseline).Significance. Our findings indicate that our innovations to the cycleGAN framework improved the quality and structure consistency of the synthetic CTs generated.
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Affiliation(s)
- Adam Szmul
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Sabrina Taylor
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Pei Lim
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jessica Cantwell
- Radiotherapy, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Isabel Moreira
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Ying Zhang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Derek D’Souza
- Radiotherapy Physics Services, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Syed Moinuddin
- Radiotherapy, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mark N. Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Jennifer Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Catarina Veiga
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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4
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Awassa L, Jdey I, Dhahri H, Hcini G, Mahmood A, Othman E, Haneef M. Study of Different Deep Learning Methods for Coronavirus (COVID-19) Pandemic: Taxonomy, Survey and Insights. Sensors (Basel) 2022; 22:1890. [PMID: 35271037 DOI: 10.3390/s22051890] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 12/15/2022]
Abstract
COVID-19 has evolved into one of the most severe and acute illnesses. The number of deaths continues to climb despite the development of vaccines and new strains of the virus have appeared. The early and precise recognition of COVID-19 are key in viably treating patients and containing the pandemic on the whole. Deep learning technology has been shown to be a significant tool in diagnosing COVID-19 and in assisting radiologists to detect anomalies and numerous diseases during this epidemic. This research seeks to provide an overview of novel deep learning-based applications for medical imaging modalities, computer tomography (CT) and chest X-rays (CXR), for the detection and classification COVID-19. First, we give an overview of the taxonomy of medical imaging and present a summary of types of deep learning (DL) methods. Then, utilizing deep learning techniques, we present an overview of systems created for COVID-19 detection and classification. We also give a rundown of the most well-known databases used to train these networks. Finally, we explore the challenges of using deep learning algorithms to detect COVID-19, as well as future research prospects in this field.
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5
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Grøan M, Ospel J, Ajmi S, Sandset EC, Kurz MW, Skjelland M, Advani R. Time-Based Decision Making for Reperfusion in Acute Ischemic Stroke. Front Neurol 2021; 12:728012. [PMID: 34790159 PMCID: PMC8591257 DOI: 10.3389/fneur.2021.728012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Decision making in the extended time windows for acute ischemic stroke can be a complex and time-consuming process. The process of making the clinical decision to treat has been compounded by the availability of different imaging modalities. In the setting of acute ischemic stroke, time is of the essence and chances of a good outcome diminish by each passing minute. Navigating the plethora of advanced imaging modalities means that treatment in some cases can be inefficaciously delayed. Time delays and individually based non-programmed decision making can prove challenging for clinicians. Visual aids can assist such decision making aimed at simplifying the use of advanced imaging. Flow charts are one such visual tool that can expedite treatment in this setting. A systematic review of existing literature around imaging modalities based on site of occlusion and time from onset can be used to aid decision making; a more program-based thought process. The use of an acute reperfusion flow chart helping navigate the myriad of imaging modalities can aid the effective treatment of patients.
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Affiliation(s)
- Mathias Grøan
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johanna Ospel
- Department of Radiology, Basel University Hospital, Basel, Switzerland.,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Soffien Ajmi
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,University of Stavanger, Stavanger, Norway
| | - Else Charlotte Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Martin W Kurz
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
| | - Mona Skjelland
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Rajiv Advani
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway
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6
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Lu F, Pan X, Zhang W, Su X, Gu Y, Qiu H, Shen S, Liu C, Liu W, Wang X, Zhan Z, Liu Z, He Z. A Three-Dimensional Imaging Method for the Quantification and Localization of Dynamic Cell Tracking Posttransplantation. Front Cell Dev Biol 2021; 9:698795. [PMID: 34557483 PMCID: PMC8452970 DOI: 10.3389/fcell.2021.698795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Cell transplantation has been proposed as a promising therapeutic strategy for curing the diseases requiring tissue repairing and functional restoration. A preclinical method to systematically evaluate the fates of donor cells in recipients, spatially and temporally, is demanded for judging therapeutic potentials for the particularly designed cell transplantation. Yet, the dynamic cell tracking methodology for tracing transplanted cells in vivo is still at its early phase. Here, we created a practical protocol for dynamically tracking cell via a three-dimensional (3D) technique which enabled us to localize, quantify, and overall evaluate the transplanted hepatocytes within a liver failure mouse model. First, the capacity of 3D bioluminescence imaging for quantifying transplanted hepatocytes was defined. Images obtained from the 3D bioluminescence imaging module were then combined with the CT scanner to reconstruct structure images of host mice. With those reconstructed images, precise locations of transplanted hepatocytes in the liver of the recipient were dynamically monitored. Immunohistochemistry staining of transplanted cells, and the serology assay of liver panel of the host mice were applied to verify the successful engraftment of donor cells in the host livers. Our protocol was practical for evaluating the engraftment efficiency of donor cells at their preclinical phases, which is also applicable as a referable standard for studying the fates of other transplanted cells, such as stem cell-derived cell types, during preclinical studies with cell transplantation therapy.
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Affiliation(s)
- Fengfeng Lu
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Stem Cells Translational Medicine, Shanghai, China.,Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China
| | - Xin Pan
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Stem Cells Translational Medicine, Shanghai, China.,Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China
| | - Wencheng Zhang
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Stem Cells Translational Medicine, Shanghai, China.,Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China
| | - Xin Su
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Stem Cells Translational Medicine, Shanghai, China.,Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China
| | - Yuying Gu
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Hua Qiu
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China.,The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shengwei Shen
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China.,Department of Hepatobiliary and Pancreatic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Changcheng Liu
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Stem Cells Translational Medicine, Shanghai, China.,Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China
| | - Wei Liu
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Stem Cells Translational Medicine, Shanghai, China.,Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China
| | - Xicheng Wang
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Stem Cells Translational Medicine, Shanghai, China.,Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China
| | - Zhenzhen Zhan
- Institute of Heart Failure, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Zhongmin Liu
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Stem Cells Translational Medicine, Shanghai, China.,Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China.,Institute of Heart Failure, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Zhiying He
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China.,Shanghai Engineering Research Center of Stem Cells Translational Medicine, Shanghai, China.,Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China
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7
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Linde L, Carter-Storch R, Christensen NL, Øvrehus KA, Diederichsen ACP, Laursen K, Jensen PS, Rasmussen LM, Møller JE, Dahl JS. Sex differences in aortic valve calcification in severe aortic valve stenosis: association between computer tomography assessed calcification and valvular calcium concentrations. Eur Heart J Cardiovasc Imaging 2021; 22:581-588. [PMID: 32500142 DOI: 10.1093/ehjci/jeaa096] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/17/2020] [Accepted: 04/16/2020] [Indexed: 01/05/2023] Open
Abstract
AIMS The aims of this study were to investigate the correlation and sex differences between total valve calcium, valve calcium concentration, and aortic valve calcification (AVC) in explanted valves from patients with severe aortic valve stenosis undergoing aortic valve replacement (AVR). METHODS AND RESULTS Sixty-nine patients with severe aortic stenosis (AS) scheduled for elective AVR underwent echocardiography and cardiac computed tomography (CT) prior to surgery (AVCin vivo) and CT of the explanted aortic valve (AVCex vivo). Explanted valves were prepared in acid solution, sonicated, and analysed with Arsenazo III dye to estimate total valve calcium and valve calcium concentration. Median AVCex vivo was 2082 (1421-2973) AU; mean valve calcium concentration was 1.43 ± 0.42 µmol Ca2+/mg tissue; median total valve calcium 156 (111-255) mg Ca2+, and valve calcium density 52 (35-81) mg/cm2. AVC displayed a strong correlation with total valve calcium (R2 = 0.98, P < 0.001) and a moderate correlation with valve calcium concentration (R2 = 0.62, P < 0.001). Valvular calcium concentration was associated with sex, aortic valve area, and mean gradient. After adjusting for age and estimated glomerular filtration rate, sex and mean gradient remained associated with valve calcium concentrations. CONCLUSION AVC score provides a strong estimate for total valve calcium but to a lesser degree calcium concentration in the valve tissue of patients with severe AS. Females presented lower valvular calcium concentrations than males irrespective of AS severity, adding evidence and providing support to the important point that sex differences in valvular calcium concentration in AS does not reflect valvular size.
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Affiliation(s)
- Louise Linde
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark.,OPEN Open Patient data Explorative Network, Denmark
| | - Rasmus Carter-Storch
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark.,OPEN Open Patient data Explorative Network, Denmark
| | | | - Kristian Altern Øvrehus
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark
| | | | - Kristian Laursen
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark
| | - Pia Søndergaard Jensen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark
| | - Lars Melholt Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark.,OPEN Open Patient data Explorative Network, Denmark.,Heart Center, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jordi Sanchez Dahl
- Department of Cardiology, Odense University Hospital, J.B Winsløws Vej 4, DK-5000 Odense C, Denmark
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Saba L, Sanagala SS, Gupta SK, Koppula VK, Johri AM, Khanna NN, Mavrogeni S, Laird JR, Pareek G, Miner M, Sfikakis PP, Protogerou A, Misra DP, Agarwal V, Sharma AM, Viswanathan V, Rathore VS, Turk M, Kolluri R, Viskovic K, Cuadrado-Godia E, Kitas GD, Sharma N, Nicolaides A, Suri JS. Multimodality carotid plaque tissue characterization and classification in the artificial intelligence paradigm: a narrative review for stroke application. Ann Transl Med 2021; 9:1206. [PMID: 34430647 PMCID: PMC8350643 DOI: 10.21037/atm-20-7676] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease (CVD) is one of the leading causes of morbidity and mortality in the United States of America and globally. Carotid arterial plaque, a cause and also a marker of such CVD, can be detected by various non-invasive imaging modalities such as magnetic resonance imaging (MRI), computer tomography (CT), and ultrasound (US). Characterization and classification of carotid plaque-type in these imaging modalities, especially into symptomatic and asymptomatic plaque, helps in the planning of carotid endarterectomy or stenting. It can be challenging to characterize plaque components due to (I) partial volume effect in magnetic resonance imaging (MRI) or (II) varying Hausdorff values in plaque regions in CT, and (III) attenuation of echoes reflected by the plaque during US causing acoustic shadowing. Artificial intelligence (AI) methods have become an indispensable part of healthcare and their applications to the non-invasive imaging technologies such as MRI, CT, and the US. In this narrative review, three main types of AI models (machine learning, deep learning, and transfer learning) are analyzed when applied to MRI, CT, and the US. A link between carotid plaque characteristics and the risk of coronary artery disease is presented. With regard to characterization, we review tools and techniques that use AI models to distinguish carotid plaque types based on signal processing and feature strengths. We conclude that AI-based solutions offer an accurate and robust path for tissue characterization and classification for carotid artery plaque imaging in all three imaging modalities. Due to cost, user-friendliness, and clinical effectiveness, AI in the US has dominated the most.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari, Italy
| | - Skandha S Sanagala
- CSE Department, CMR College of Engineering & Technology, Hyderabad, India.,CSE Department, Bennett University, Greater Noida, UP, India
| | - Suneet K Gupta
- CSE Department, Bennett University, Greater Noida, UP, India
| | - Vijaya K Koppula
- CSE Department, CMR College of Engineering & Technology, Hyderabad, India
| | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, Rhode Island, USA
| | - Martin Miner
- Men's Health Center, Miriam Hospital Providence, Rhode Island, USA
| | - Petros P Sfikakis
- Rheumatology Unit, National Kapodistrian University of Athens, Greece
| | - Athanasios Protogerou
- Department of Cardiovascular Prevention, National and Kapodistrian University of Athens, Athens, Greece
| | - Durga P Misra
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Lucknow, India
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, University of Virginia, VA, USA
| | - Vijay Viswanathan
- MV Hospital for Diabetes & Professor M Viswanathan Diabetes Research Centre, Chennai, India
| | - Vijay S Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, USA
| | - Monika Turk
- The Hanse-Wissenschaftskolleg Institute for Advanced Study, Delmenhorst, Germany
| | | | | | | | - George D Kitas
- R & D Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Neeraj Sharma
- Department of Biomedical Engineering, IIT-BHU, Banaras, UP, India
| | - Andrew Nicolaides
- Vascular Screening and Diagnostic Centre, University of Nicosia, Nicosia, Cyprus
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA
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9
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Zhou X, Ye Q, Jiang Y, Wang M, Niu Z, Menpes-Smith W, Fang EF, Liu Z, Xia J, Yang G. Systematic and Comprehensive Automated Ventricle Segmentation on Ventricle Images of the Elderly Patients: A Retrospective Study. Front Aging Neurosci 2020; 12:618538. [PMID: 33390930 PMCID: PMC7772233 DOI: 10.3389/fnagi.2020.618538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Ventricle volume is closely related to hydrocephalus, brain atrophy, Alzheimer's, Parkinson's syndrome, and other diseases. To accurately measure the volume of the ventricles for elderly patients, we use deep learning to establish a systematic and comprehensive automated ventricle segmentation framework. Methods: The study participation included 20 normal elderly people, 20 patients with cerebral atrophy, 64 patients with normal pressure hydrocephalus, and 51 patients with acquired hydrocephalus. Second, get their imaging data through the picture archiving and communication systems (PACS) system. Then use ITK software to manually label participants' ventricular structures. Finally, extract imaging features through machine learning. Results: This automated ventricle segmentation method can be applied not only to CT and MRI images but also to images with different scan slice thicknesses. More importantly, it produces excellent segmentation results (Dice > 0.9). Conclusion: This automated ventricle segmentation method has wide applicability and clinical practicability. It can help clinicians find early disease, diagnose disease, understand the patient's disease progression, and evaluate the patient's treatment effect.
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Affiliation(s)
- Xi Zhou
- Department of Radiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Qinghao Ye
- Hangzhou Ocean's Smart Boya Co., Ltd., Hangzhou, China.,Mind Rank Ltd., Hongkong, China
| | - Yinghui Jiang
- Hangzhou Ocean's Smart Boya Co., Ltd., Hangzhou, China.,Mind Rank Ltd., Hongkong, China
| | - Minhao Wang
- Hangzhou Ocean's Smart Boya Co., Ltd., Hangzhou, China.,Mind Rank Ltd., Hongkong, China
| | - Zhangming Niu
- Aladdin Healthcare Technologies Ltd., London, United Kingdom
| | | | - Evandro Fei Fang
- Department of Clinical Molecular Biology, University of Oslo, Oslo, Norway
| | - Zhi Liu
- School of Information Science and Engineering, Shandong University, Qingdao, China
| | - Jun Xia
- Department of Radiology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
| | - Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Lupean R, Ștefan P, Oancea MD, Măluțan AM, Lebovici A, Pușcaș ME, Csutak C, Mihu CM. Computer Tomography in the Diagnosis of Ovarian Cysts: The Role of Fluid Attenuation Values. Healthcare (Basel) 2020; 8:398. [PMID: 33066370 PMCID: PMC7711840 DOI: 10.3390/healthcare8040398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/18/2022] Open
Abstract
Pathological analysis of ovarian cysts shows specific fluid characteristics that cannot be standardly evaluated on computer tomography (CT) examinations. This study aimed to assess the ovarian cysts’ fluid attenuation values on the native (Np), arterial (Ap), and venous (Vp) contrast phases of seventy patients with ovarian cysts who underwent CT examinations and were retrospectively included in this study. Patients were divided according to their final diagnosis into the benign group (n = 32) and malignant group (n = 38; of which 27 were primary and 11 were secondary lesions). Two radiologists measured the fluid attenuation values on each contrast phase, and the average values were used to discriminate between benign and malignant groups and primary tumors and metastases via univariate, multivariate, multiple regression, and receiver operating characteristics analyses. The Ap densities (p = 0.0002) were independently associated with malignant cysts. Based on the densities measured on all three phases, neoplastic lesions could be diagnosed with 89.47% sensitivity and 62.5% specificity. The Np densities (p = 0.0005) were able to identify metastases with 90.91% sensitivity and 70.37% specificity, while the combined densities of all three phases diagnosed secondary lesions with 72.73% sensitivity and 92.59% specificity. The ovarian cysts’ fluid densities could function as an adjuvant criterion to the classic CT evaluation of ovarian cysts.
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Zaharie A, Bolboacă SD, Moisoiu T, Burghelea D, Iacob G, Ghervan L, Elec FI. Renal Tumors in Young Adults: Is Preoperative Computer Tomography Imaging Suggestive for the Nature of the Tumors? Diagnostics (Basel) 2020; 10:diagnostics10060380. [PMID: 32517346 PMCID: PMC7345588 DOI: 10.3390/diagnostics10060380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 01/20/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for 2–3% of all adult malignant neoplasms and is even rarer in patients under 45 years old. Clear-cell carcinoma represents most of the pathological subtypes. Our study aimed to investigate the association between preoperative computer tomography imagistic evaluation and histopathological diagnosis of renal tumors in young adults. Patients younger than 45 years old with renal tumors who were referred for medical treatment at the Clinical Institute of Urology and Renal Transplantation Cluj-Napoca from 2012 to 2019 were considered eligible for the study. Medical charts were retrospectively reviewed, and patients with complete data regarding preoperative diagnostic, histopathological evaluation, and follow-up data, regardless of gender, were included in the study. Sixteen patients younger than 45 years fulfilled all the inclusion criteria and were evaluated. With two exceptions, the evaluated patients were in a T1 and T2 stage, with no vascular invasion or of the adjacent organs. Two-thirds of our patients had a clear-cell renal cell carcinoma. None of our patients fitted in the low complexity surgery category of the R.E.N.A.L. Nephrometry Score and 37.5% of them benefited from partial nephrectomy. Half of the suppositions made based on imaging were concordant with the histopathology report. Fifteen of the patients showed no recurrence during the respective follow-up interval. Computer tomography imaging reports showed on our sample a higher concordance with the histopathological report in the more common subtypes (namely Renal Clear Cell RCC), with typical appearances.
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Affiliation(s)
- Andreea Zaharie
- Department of Medical Imaging, “Leon Daniello” Pulmonology Hospital, Cluj-Napoca, Bogdan Petriceicu Hașdeu Street, no. 6, 400332 Cluj-Napoca, Romania
- Correspondence: (A.Z.); (S.D.B.); (F.I.E.); Tel.: +40-762-298-833 (A.Z.); +40-374-834-506 (S.D.B.); +40-722-822-740 (F.I.E.)
| | - Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Str., no. 6, 400349 Cluj-Napoca, Romania
- Correspondence: (A.Z.); (S.D.B.); (F.I.E.); Tel.: +40-762-298-833 (A.Z.); +40-374-834-506 (S.D.B.); +40-722-822-740 (F.I.E.)
| | - Tudor Moisoiu
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
| | - Dan Burghelea
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
| | - Gheorghita Iacob
- Department of Pathology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania;
| | - Liviu Ghervan
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
- Department of Urology, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania
| | - Florin Ioan Elec
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
- Department of Urology, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania
- Correspondence: (A.Z.); (S.D.B.); (F.I.E.); Tel.: +40-762-298-833 (A.Z.); +40-374-834-506 (S.D.B.); +40-722-822-740 (F.I.E.)
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Abstract
Background With the popularization of minimal invasive surgery, video-assisted thoracoscopic surgery (VATS) is gradually replacing conventional thoracotomy for lung cancer and is even used for osteosarcoma patients with pulmonary metastasis. In this study, we characterized the need for open surgery by comparing computer tomography (CT) diagnosis and postoperative pathology of patients with pulmonary metastases of osteosarcoma. Methods A retrospective analysis was carried out on patients with underwent surgery for pulmonary metastatic osteosarcoma admitted to our hospital between January 2008 and July 2018. The numbers of pulmonary metastatic nodules suspected by preoperative CT scan were calculated in addition to the number of nodules which were resected and pathologically confirmed to be metastatic during surgery. The Spearman correlation coefficient between the number of nodules on preoperative CT scan and the number of lesions pathologically confirmed was calculated. Results In total, 69 patients undergoing 96 thoracotomy operations were included in this study. The median interval between preoperative CT examination and operation was 7 days (range, 1-44 days). The median number of the suspected nodules on preoperative CT and the pathologically positive metastases resected during operation were 1 and 3, respectively. Remarkably, 36 (37.5%) thoracotomies revealed that more metastatic nodules were detected during thoracotomy than preoperative CT scans. Conclusions Preoperative CT examination omits a few small pulmonary metastases of osteosarcoma and there is rare progress in recent years. Therefore, we recommend that patients with pulmonary metastases of undergo thoracotomy to locate and resect all metastases as much as possible through intraoperative direct palpation.
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Affiliation(s)
- Erji Gao
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yang Li
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Weigang Zhao
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Tiancheng Zhao
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Xiang Guo
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Weiwei He
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Weiming Wu
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yonghong Zhao
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yi Yang
- Department of Thoracic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Shahedi M, Halicek M, Guo R, Zhang G, Schuster DM, Fei B. A semiautomatic segmentation method for prostate in CT images using local texture classification and statistical shape modeling. Med Phys 2018; 45:2527-2541. [PMID: 29611216 DOI: 10.1002/mp.12898] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 03/15/2018] [Accepted: 03/24/2018] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Prostate segmentation in computed tomography (CT) images is useful for treatment planning and procedure guidance such as external beam radiotherapy and brachytherapy. However, because of the low, soft tissue contrast of CT images, manual segmentation of the prostate is a time-consuming task with high interobserver variation. In this study, we proposed a semiautomated, three-dimensional (3D) segmentation for prostate CT images using shape and texture analysis and we evaluated the method against manual reference segmentations. METHODS The prostate gland usually has a globular shape with a smoothly curved surface, and its shape could be accurately modeled or reconstructed having a limited number of well-distributed surface points. In a training dataset, using the prostate gland centroid point as the origin of a coordination system, we defined an intersubject correspondence between the prostate surface points based on the spherical coordinates. We applied this correspondence to generate a point distribution model for prostate shape using principal component analysis and to study the local texture difference between prostate and nonprostate tissue close to the different prostate surface subregions. We used the learned shape and texture characteristics of the prostate in CT images and then combined them with user inputs to segment a new image. We trained our segmentation algorithm using 23 CT images and tested the algorithm on two sets of 10 nonbrachytherapy and 37 postlow dose rate brachytherapy CT images. We used a set of error metrics to evaluate the segmentation results using two experts' manual reference segmentations. RESULTS For both nonbrachytherapy and post-brachytherapy image sets, the average measured Dice similarity coefficient (DSC) was 88% and the average mean absolute distance (MAD) was 1.9 mm. The average measured differences between the two experts on both datasets were 92% (DSC) and 1.1 mm (MAD). CONCLUSIONS The proposed, semiautomatic segmentation algorithm showed a fast, robust, and accurate performance for 3D prostate segmentation of CT images, specifically when no previous, intrapatient information, that is, previously segmented images, was available. The accuracy of the algorithm is comparable to the best performance results reported in the literature and approaches the interexpert variability observed in manual segmentation.
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Affiliation(s)
- Maysam Shahedi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Martin Halicek
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Rongrong Guo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Guoyi Zhang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - David M Schuster
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Baowei Fei
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, 30322, USA.,Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, 30332, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, 30322, USA.,Department of Mathematics and Computer Science, Emory University, Atlanta, GA, 30322, USA
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Balakin BV, Farbu E, Kosinski P. Aerodynamic evaluation of the empty nose syndrome by means of computational fluid dynamics. Comput Methods Biomech Biomed Engin 2017; 20:1554-1561. [PMID: 29064287 DOI: 10.1080/10255842.2017.1385779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The potential outcome of a surgical enlargement of internal nasal channels may be a complication of nasal breathing termed the Empty Nose Syndrome (ENS). ENS pathophysiology is not entirely understood because the expansion of air pathways would in theory ease inhalation. The present contribution is aimed at defining the biophysical markers responsible for ENS. Our study, conducted in silico, compares nasal aerodynamics in pre- and post-operative geometries acquired by means of computer tomography from the same individual. In this article, we elucidate and analyse the deviation of airflow patterns and nasal microclimate from the healthy benchmarks. The analysis reveals 53% reduction in flow resistance, radical re-distribution of nasal airflow, as well as dryer and colder nasal microclimate for the post-operative case.
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Affiliation(s)
- Boris V Balakin
- a Department of Mechanical and Marine Engineering , Western Norway University of Applied Sciences , Bergen , Norway.,b Department of Thermal Physics , National Nuclear Research University MEPhI , Moscow , Russia
| | - Erlend Farbu
- a Department of Mechanical and Marine Engineering , Western Norway University of Applied Sciences , Bergen , Norway
| | - Pawel Kosinski
- c Department of Physics and Technology , University of Bergen , Bergen , Norway
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Liu H, Liu J, Zhang Y, Liao J, Tong Q, Gao F, Hu Y, Wang W. Contrast-enhanced ultrasound and computerized tomography perfusion imaging of a liver fibrosis-early cirrhosis in dogs. J Gastroenterol Hepatol 2016; 31:1604-10. [PMID: 26878817 DOI: 10.1111/jgh.13320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/25/2016] [Accepted: 02/10/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIM To assess liver fibrosis stages in a liver fibrosis-early cirrhosis model in dogs, the clinical efficiency of contrast-enhanced ultrasound (CEUS) and computed tomography (CT) perfusion imaging were compared. METHODS Hepatic vein arriving time (HVAT), hepatic artery arriving time, and hepatic artery to vein transit time (HA-VTT) were measured on CEUS. Total liver perfusion (TLP), portal vein perfusion (PVP), hepatic artery perfusion, and hepatic perfusion index (HPI) were measured on CT perfusion imaging. Histologic examination of liver specimens of the animals was performed to assess the fibrosis stage. RESULTS For assessment of liver fibrosis, the area under the receiver operating characteristic curve of CEUS indexes HVAT and HA-VTT were 0.865 and 0.930, respectively; the perfusion CT indexes TLP, PVP, and HPI were 0.797, 0.800, and 0.220, respectively; the serological index hyaluronic acid was 0.793. While for assessment of early cirrhosis, the area under the receiver operating characteristic curve of CEUS indexes HVAT and HA-VTT were 0.915 and 0.948, respectively; the perfusion CT indexes TLP, PVP, and HPI were 0.737, 0.765, and 0.218, respectively; the serological index hyaluronic acid was 0.627. CONCLUSIONS This study showed that both CEUS and CT perfusion imaging have the potential to be complementary imaging tools in the evaluation of liver fibrosis. While CEUS is the better choice and the index HA-VTT can be considered as non-invasive semi-quantitative indexes for diagnosing liver fibrosis and early cirrhosis.
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Affiliation(s)
- Huanghui Liu
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jun Liu
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Yaqin Zhang
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jian Liao
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Qiongjuan Tong
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Feng Gao
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yuequn Hu
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Wei Wang
- Department of Medical Imaging, The Third Xiangya Hospital of Central South University, Changsha, China
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Abstract
BACKGROUND The aim of this study was to determine the computed tomography (CT) features potentially helpful for accurate staging and predicting resectability of thymic epithelial tumors (TET). METHODS One hundred and thirty-eight consecutive TET patients undergoing surgical resection from April 2010 to November 2011 were prospectively entered into a database. All patients were staged according to the Masaoka-Koga staging system. The relationship between CT features with tumor staging and complete resection was reviewed after surgery. RESULTS Surgico-pathological staging was stage I in 63, stage II in 32, stage III in 32, and stage IV in 11 patients. Preoperative CT staging was highly consistent with postoperative surgico-pathological staging (Kappa =0.525). Tumor shape, contour, enhancement, with or without invasion of the adjacent structures (mediastinal fat, mediastinal pleura, lung, pericardium, mediastinal vessels, phrenic nerve), and presence of pleural, pericardial effusionor intrapulmonary metastasis were correlated with Masaoka-Koga staging (P<0.05). However, tumor size, internal density or presence of calcification was not associated with staging (P>0.05). Tumor size, presence of calcification and mediastinal lymph node enlargement were not correlated with complete tumor resection (P>0.05). Tumor shape, contour, internal density, enhancement pattern, and invasion of adjacent structures were related to complete resection of the primary tumor in univariate analysis (P<0.05). However, upon multivariate logistic regression, only absence of artery systems invasion was predictive of complete resection (P<0.05). CONCLUSIONS Clinical staging of TET could be accurately evaluated with CT features including tumor shape, contour, enhancement pattern, with or without invasion of adjacent structures, and presence of pleural, pericardial effusion or intrapulmonary metastasis. Absence of arterial system invasion on CT was the only predictive feature for predicting complete resection of TET.
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Affiliation(s)
- Yan Shen
- 1 Department of Radiology, 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Zhitao Gu
- 1 Department of Radiology, 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jianding Ye
- 1 Department of Radiology, 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Teng Mao
- 1 Department of Radiology, 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- 1 Department of Radiology, 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wenhu Chen
- 1 Department of Radiology, 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Gruionu LG, Săftoiu A, Popa T, Ciobârcă C, Streba CT, Ioncică AM, Gruionu G. Feasibility Study of a Novel Navigation System for Biopsy of Peripheral Lesions in the Lungs. Curr Health Sci J 2016; 42:76-81. [PMID: 30568816 DOI: 10.12865/CHSJ.42.01.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/28/2016] [Indexed: 11/30/2022]
Abstract
A novel system for electromagnetic navigation in bronchoscopy (ENB) to improve peripheral lesion targeting and diagnostic is currently under development, and preliminary tests on a complex phantom are presented in this paper. The system named Transbite is proving to be easy to use, accurate and useful for experienced and beginner users, with precision around 5-9 mm in reaching targets in sub-segmental bronchi where a conventional video-bronchoscope cannot extent. Transbite system consists of a planning and orientation software, a navigation and biopsy forceps, an active marker that is placed on patient chest and an electromagnetic tracking system from the market connected to a computer containing the software. Transbite can be used with any bronchoscopy system, has a short set-up procedure and learning curve.
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Savaridas SL, Spratt JD, Cox J. Incidence and Potential Significance of Internal Mammary Lymphadenopathy on Computed Tomography in Patients with a Diagnosis of Primary Breast Cancer. Breast Cancer (Auckl) 2015; 9:59-65. [PMID: 26309406 PMCID: PMC4525791 DOI: 10.4137/bcbcr.s25782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/03/2015] [Accepted: 05/05/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The importance of internal mammary nodes (IMNs) in the staging and treatment of breast cancer patients is controversial. METHODS A retrospective cohort of patients diagnosed with primary breast cancer over a 4-year period (January 2009 to December 2012) was assessed. The number and size of any IMNs visible on spiral computed tomography (CT) were recorded. RESULTS A total of 830 patients were diagnosed with primary breast cancer within the identified time frame, of which 150 patients met the inclusion criteria. Of these 42% (63) had IMNs present, although the majority were small (<5 mm). However, 16% (25) had larger nodes, greater than 5 mm in short axis, present on CT. Significantly more patients with the presence of large (>5 mm) IMNs had more advanced disease with CT evidence of other distant spread. CONCLUSION We have demonstrated that IMNs are present in a substantial number of our primary breast cancer patients. We suggest that further histological research is required to establish reliable CT size criterion for pathological IMNs. In addition, routine imaging of the IM chain, as well as axilla, should be considered in the staging of breast cancer.
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Affiliation(s)
- Sarah L Savaridas
- University Hospital of North Durham, Durham, County Durham, UK. ; North Tyneside General Hospital, North Shields, Tyne-and-Wear, UK
| | | | - Julie Cox
- Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK
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Bajenaru N, Balaban V, Săvulescu F, Campeanu I, Patrascu T. Hepatic hemangioma -review-. J Med Life 2015; 8 Spec Issue:4-11. [PMID: 26361504 PMCID: PMC4564031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 05/20/2015] [Indexed: 11/13/2022] Open
Abstract
Hepatic hemangiomas are benign tumors of the liver consisting of clusters of blood-filled cavities, lined by endothelial cells, fed by the hepatic artery. The vast majority of HH are asymptomatic, most often being discovered incidentally during imaging investigations for various unrelated pathologies. Typical hemangiomas, the so-called capillary hemangiomas, range from a few mm to 3 cm, do not increase in size over time and therefore are unlikely to generate future symptomatology. Small (mm-3 cm) and medium (3 cm-10 cm) hemangiomas are well-defined lesions, requiring no active treatment beside regular follow-ups. However, the so-called giant liver hemangiomas, of up to 10 cm (most commonly) and even 20+ cm in size (according to occasional reports) can, and usually will develop symptoms and complications that require prompt surgical intervention or other kind of therapy. HH belong to the class of hepatic "incidentalomas", so-called because they are diagnosed incidentally, on imaging studies performed as routine examinations or for other reasons than the evaluation of a possible liver mass. Less than half of HH present with overt clinical symptoms, consisting, most often, of upper abdominal pain (this is usually the case for large lesions, which cause the distension of Glisson's capsule). Hepatic hemangiomas require a careful diagnosis to differentiate from other focal hepatic lesions, co-occurring diagnoses are also possible.
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Affiliation(s)
- N Bajenaru
- Department of Surgery II, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | - V Balaban
- Gastroenterology Clinic, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | - F Săvulescu
- Department of Surgery II, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | - I Campeanu
- Department of Surgery, "Sf. Maria" Clinical Hospital, Bucharest, Romania
| | - T Patrascu
- "I. Juvara" Department of Surgery, "Dr. I. Cantacuzino" Clinical Hospital, Bucharest, Romania
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Buitrago-Téllez CH, Cornelius CP, Prein J, Kunz C, Ieva AD, Audigé L. The Comprehensive AOCMF Classification System: Radiological Issues and Systematic Approach. Craniomaxillofac Trauma Reconstr 2014; 7:S123-30. [PMID: 25489396 PMCID: PMC4251726 DOI: 10.1055/s-0034-1389565] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The AOCMF Classification Group developed a hierarchical three-level craniomaxillofacial (CMF) classification system with increasing level of complexity and details. The basic level 1 system differentiates fracture location in the mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94); the levels 2 and 3 focus on defining fracture location and morphology within more detailed regions and subregions. Correct imaging acquisition, systematic analysis, and interpretation according to the anatomic and surgical relevant structures in the CMF regions are essential for an accurate, reproducible, and comprehensive diagnosis of CMF fractures using that system. Basic principles for radiographic diagnosis are based on conventional plain films, multidetector computed tomography, and magnetic resonance imaging. In this tutorial, the radiological issues according to each level of the classification are described.
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Affiliation(s)
- Carlos H. Buitrago-Téllez
- Institute of Radiology Zofingen Hospital, Zofingen, Switzerland
- Hightech Research Center for CMF Surgery, University of Basel, Basel, Switzerland
| | - Carl-Peter Cornelius
- Department of Oral and Maxillofacial Surgery, Ludwig Maximilians Universität, München, Germany
| | - Joachim Prein
- Clinic for Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Christoph Kunz
- Clinic for Oral and Craniomaxillofacial Surgery, University Hospital Basel, Basel, Switzerland
| | - Antonio di Ieva
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Laurent Audigé
- AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland
- Research and Development Department, Schulthess Clinic, Zürich, Switzerland
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Nevárez A, Saftoiu A, Bhutani M. Primary Small Cell Carcinoma of the Esophagus: Clinico- pathological Features and Therapeutic Options. Curr Health Sci J 2011; 37:31-4. [PMID: 24778832 PMCID: PMC3994671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 01/21/2011] [Indexed: 11/24/2022]
Abstract
Primary esophageal small cell carcinoma (SmCC) is a rare disease with a poor prognosis despite agressive multimodality combination treatment. This article presents the case of a 76-year old women diagnosed with pimary esophageal SmCC. The diagnosis was established by upper gastrointestinal endoscopy with biopsies that confirmed an esophageal SmCC positive to synaptophysin, chromogranin, CD56, TTF-1, and cytokeratin 8/18. Further staging procedures included CT, PET and EUS, followed by combination chemotherapy and radiotherapy. Restaging was then performed, again with PET and CT of the thorax, abdomen and pelvis. This was then followed by salvage esophagectomy due to the presence of residual tumor. Surgical pathology confirmed a 3 cm SmCC, with invasion of the submucosa and lymphovascular invasion. In conclusion, the article describes the rare occurrence of esophageal SmCC, together with the algorithm of diagnosis and staging based on state-of-the-art imaging methods. This was followed by combination chemoradiotherapy and surgical esophagectomy as the standard of care in this aggressive disease.
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Affiliation(s)
| | - A. Saftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, România
| | - M.S. Bhutani
- Department of Gastroenterology,Hepatology and Nutrition, UT MD Anderson Cancer Center, Houston,Texas,USA
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