Ultrasound IMT measurement on a multi-ethnic and multi-institutional database: our review and experience using four fully automated and one semi-automated methods

Automated and high performance carotid intima-media thickness (IMT) measurement is gaining increasing importance in clinical practice to assess the cardiovascular risk of patients. In this paper, we compare four fully automated IMT measurement techniques (CALEX, CAMES, CARES and CAUDLES) and one semi-automated technique (FOAM). We present our experience using these algorithms, whose lumen-intima and media-adventitia border estimation use different methods that can be: (a) edge-based; (b) training-based; (c) feature-based; or (d) directional Edge-Flow based. Our database (DB) consisted of 665 images that represented a multi-ethnic group and was acquired using four OEM scanners. The performance evaluation protocol adopted error measures, reproducibility measures, and Figure of Merit (FoM). FOAM showed the best performance, with an IMT bias equal to 0.025±0.225mm, and a FoM equal to 96.6%. Among the four automated methods, CARES showed the best results with a bias of 0.032±0.279mm, and a FoM to 95.6%, which was statistically comparable to that of FOAM performance in terms of accuracy and reproducibility. This is the first time that completely automated and user-driven techniques have been compared on a multi-ethnic dataset, acquired using multiple original equipment manufacturer (OEM) machines with different gain settings, representing normal and pathologic cases.

Carotid IMT variability (IMTV) and its validation in symptomatic versus asymptomatic Italian population: can this be a useful index for studying symptomaticity?

The carotid intima-media thickness (IMT) is a validated marker of cerebrovascular disease risk. This paper presents a new parameter, the IMT variability (IMTV), and compares it between symptomatic and asymptomatic patients taken from a cohort of Italian population. One hundred forty-two patients were analyzed (age 59 ± 112 years, 59% males), 42 of these patients suffered from TIA or minor stroke. The lumen-intima (LI) and media-adventitia (MA) interfaces of the far wall were manually traced by a Reader. We also used a computer-based automated system (called AutoEdge) to obtain the LI/MA interfaces. The LI/MA interfaces were used to measure the IMT and the IMTV along the distal wall of the common carotid artery. Wilcoxon and Pearson correlation analyses were performed. The agreement between the Reader's IMT and the AutoEdge IMT values was 98.7% for the symptomatic (0.83 ± 0.44 mm for Reader, 0.82 ± 0.35 mm for AutoEdge) and 94.9% for the asymptomatic patients (0.78 ± 0.45 mm for Reader, 0.74 ± 0.30 mm for AutoEdge). Correlation was 65% for symptomatic and 68% for asymptomatic patients, respectively. The IMT measured using AutoEdge was 1.2% lower compared to manual measurements in symptomatic population, while 5.12% lower in asymptomatic. The IMTV was 11% higher in symptomatic patients compared to asymptomatic when using manual delineations, 8% higher when using AutoEdge. There was no statistical difference between the manual and automated IMTV measurements (Wilcoxon signed rank, P > 0.7). We conclude that the IMT and IMTV values were very similar between Reader and AutoEdge software when studying symptomatic and asymptomatic patients in Italian population.

Utility of echocardiography in the diagnosis of aortic dissection involving the ascending aorta

We report our prospective experience with sensitivity, specificity, predictive values and efficiency of echocardiography in diagnosing AD involving the ascending aorta (type A). We studied two groups of patients with both echocardiography and aortography. Group 1 was made up by 46 consecutive patients with clinical suspicion of AD. Type A AD was confirmed in 23 cases. Group 2 was comprised of 509 adult patients who had been studied during the same period with both aortography and echocardiography (including 46 patients from group 1); prevalence of type A AD in this group was 4.9 percent. We conclude that the diagnostic usefulness of echocardiography in patients with suspected type A AD is limited by its moderate sensitivity and predictive positive value. Aortography remains the major step in diagnosis. Within these limitations, echocardiography is useful in confirmation of clinical suspicion if all three main echocardiographic signs are present (predictive positive value: 100 percent).

PedNavigator: a pedigree drawing servlet for large and inbred populations

PedNavigator is a pedigree drawing application for large and complex pedigrees. It has been developed especially for genetic and epidemiological studies of isolated populations characterized by high inbreeding and multiple matrimonies. PedNavigator is written in Java and is intended as a server-side web application, allowing researchers to 'walk' through family ties by point-and-clicking on person's symbols. The application is able to enrich the pedigree drawings with genotypic and phenotypic information taken from the underlying relational database.

Occurrence of hexabromocyclododecanes and tetrabromobisphenol A in fish and seafood from the sea of Sardinia - FAO 37.1.3 area: Their impact on human health within the European Union marine framework strategy directive

Levels of hexabromocyclododecane isomers α, β, γ, (HBCDDs) and tetrabromobisphenol A (TBBP-A) were determined in 24 representative samples of different wild fish and seafood species (benthic: N = 16; pelagic: N = 8) and 16 samples of farmed bivalve molluscs from the West Mediterranean Sea (FAO 37, 1.3 sub-area). An LC-MS/MS-based method with limits of quantification (LOQS) in the range of 0.01-0.05 ng g^-1 fresh weight (fw) was utilized. While α HBCDD was found in 80% of the 24 wild species samples, β and γ congeners were found in 33% and 25%, respectively. ΣHBCDD content ranged from 0.03 (Aristeus antennatus) to 0.68 (Sardina pilchardus) ng g^-1 fw as Upper Bound values across 2.00-4.46 trophic levels. In farmed molluscs, HBCDD congeners were always present and ranged from 0.22-0.52 ng g^-1 fw, with the exception of one farm (1.23-2.06 ng g^-1 fw), whose values suggest the presence of a regular emission source. TBBP-A levels always fell below the LOQ of 0.05 ng g^-1 fw in all samples. The results are in good agreement with results of previous studies from the Mediterranean Sea. The Environmental Quality Standard for human health from fish and seafood local consumption was set at 165 μg g^-1 fw. The Margin of Exposure of 490,020 as the ratio between the considered Health Based Guidance Level of 0.79 mg kg^-1 body weight and the geo-referenced HBCDD intake (P95 fish and seafood intake; mean ΣHBCDD contamination) indicates no threat to food safety.

Browsing isolated population data

Background

In our studies of genetically isolated populations in a remote mountain area in the center of Sardinia (Italy), we found that 80–85% of the inhabitants of each village belong to a single huge pedigree with families strictly connected to each other through hundreds of loops. Moreover, intermarriages between villages join pedigrees of different villages through links that make family trees even more complicated. Unfortunately, none of the commonly used pedigree drawing tools are able to draw the complete pedigree, whereas it is commonly accepted that the visual representation of families is very important as it helps researchers in identifying clusters of inherited traits and genotypes. We had a representation issue that compels researchers to work with subsets extracted from the overall genealogy, causing a serious loss of information on familiar relationships.

To visually explore such complex pedigrees, we developed PedNavigator, a browser for genealogical databases properly suited for genetic studies.

Results

The PedNavigator is useful for genealogical research due to its capacity to represent family relations between persons and to make a visual verification of the links during family history reconstruction. As for genetic studies, it is helpful to follow propagation of a specific set of genetic markers (haplotype), or to select people for linkage analysis, showing relations between various branch of a family tree of affected subjects.

Availability

PedNavigator is an application integrated into a Framework designed to handle data for human genetic studies based on the Oracle platform. To allow the use of PedNavigator also to people not owning the same required informatics infrastructure or systems, we developed PedNavigator Lite with mainly the same features of the integrated one, based on MySQL database server. This version is free for academic users, and it is available for download from our site

Does the clinical information play a role in the magnetic resonance diagnostic confidence analysis of ovarian and deep endometriosis?

OBJECTIVE:

Some recent studies have explored how the experience in the observers change their performance in the endometriosis detection using MRI but the effects of the clinical information remains uncertain. The purpose of this study was to assess the effect of the clinical information in the diagnostic confidence in the MRI diagnosis of endometriosis.

METHODS AND MATERIALS:

Institutional Review Board was obtained. This study is compliant to STARD method. 80 patients (mean age 32 years; range 19 - 46 years) who had undergone MRI study and surgery for suspected endometriosis were retrospectively evaluated. MRI exams were performed with a 1.5 T scanner and the following five locations were assessed: ovary, anterior compartment, vaginal fornix, utero-sacral ligaments, and Rectum\Sigmoid\Pouch of Douglas. Data sets were evaluated twice on a 5-point scale by four radiologists with different level of expertise; the first time blinded to the clinical information and the second time, after 3 months together with the clinical chart. Statistical analysis included receiver operating characteristics curve analysis, the Cohen weighted test and sensitivity, specificity, positive predictive value, negative predictive value, accuracy, LR+ and LR-.

RESULTS:

A total of 140 localization of endometriosis (47 endometriomas and 93 endometriotic nodules) were found. The pairwise comparison demonstrated that in all cases the presence of clinical information improved the Az value. The concordance analysis indicated a mixed pattern from modest agreement (weighted κ value 0.556 for anterior compartment) to excellent agreement values (weighted κ value 0.867 for ovarian endometriomas).

CONCLUSION:

The results of our study suggest that clinical information is useful in diagnosing endometriosis in general anterior compartment, but not in other locations. Less experienced radiologists (resident) may benefit from it at utero-sacral ligaments or Rectum\Sigmoid\Pouch of Douglas.

ADVANCES IN KNOWLEDGE:

In this era of sometimes indiscriminate use of diagnostic methods, it is important to emphasis the context for interpretation of diagnostic results. Our paper confirms that clinical information is useful in diagnosing endometriosis.

Emerging Mycotoxins in Cheese: Simultaneous Analysis of Aflatoxin M1, Aflatoxicol, and Sterigmatocystin by LC-MS/MS

The presence of mycotoxins in cheese is a significant concern due to their potential health risks. Mycotoxins can contaminate cheese through two main routes: indirectly via contaminated animal feed, and/or directly, because of mold growth on dairy products. It has been reported that cheese may contain metabolites of aflatoxin B1 such as aflatoxin M1 (AFM1), aflatoxicol (AFL), and, its precursor, sterigmatocystin (STC). This study presents a reliable method for the simultaneous determination of AFM1, AFL, and STC in cheeses made from ovine, goat, or buffalo milk. The method was developed using single liquid extraction, clean-up by an immunoaffinity column (IAC), and liquid chromatography-tandem mass spectrometry (LC-MS/MS) determination. The method was subjected to initial validation according to EU regulations, which outline the required performance parameters and criteria of analytical methods for official food control. The limits of quantification (LOQs) of the method for AFM1, AFL, and STC are 2.0 ng/kg, 5.0 ng/kg, and 1.0 ng/kg, respectively. The method was applied in a study for the assessment of mycotoxin transfer from milk to cheeses and also their growth.

Automated IMT estimation and BMI correlation using a low-quality carotid ultrasound image database from India

This paper presents AtheroEdgeLowRes (AELR), an extention of AtheroEdge™ from AtheroPoint™, and a solution to carotid ultrasound IMT measurement in low-resolution and overall low quality images. The images were collected using a low-end ultrasound machine during a screening study in India. We aim to demonstrate the accuracy and reproducibility of the AELR system by benchmarking it against an expert Reader's manual tracing and to show the correlation between the automatically measured intima media thickness (IMT) and the subjects' cardiovascular risk factors (i.e. body mass index--BMI). We introduced an innovative penalty function (PF) to our dual-snake segmentation technique, necessary due to the low image resolution. We processed 512 images from 256 patients, and correlated the AELR IMT values with the patients' age and BMI. AELR processed all 512 images, and the IMT measurement error was 0.011±0.099 mm with the PF correction and 0.173±0.127 mm without. AELR IMT values correlated with the Reader's values (r = 0.883) and also correlated with the subject's BMI and age. The AELR system showed accuracy and reproducibility levels that make it suitable to be used in large epidemiological and screening studies in emerging countries.

Carotid IMT variability (IMTV): its design and validation in symptomatic vs. asymptomatic 142 Italian population

The carotid intima-media thickness (IMT) is a validated marker of cerebrovascular disease risk. This work presents a new parameter, the IMT variability (IMTV), and compares the IMT and IMTV in symptomatic and asymptomatic Italian patients. 142 patients were analyzed (age 59±11.2 years, 59% males), 42 of which suffered from TIA (transient ischemic attack) or minor stroke. The lumen-intima (LI) and media-adventitia (MA) interfaces were manually traced by a Reader, and automatically traced by an automated system (AutoEdge). These interfaces were then used to measure the IMT and IMTV along the carotid wall. Wilcoxon and Pearson correlation analyses were performed. There was about a 65% correlation between the manual and automated measurements of IMT. There was no statistical difference between the manual and automated IMTV measurements (Wilcoxon signed rank, p>0.7). The observed mean IMT for symptomatic patients (0.83±0.44 mm for Reader vs. 0.82±0.35 mm for AutoEdge) was higher compared to asymptomatic patients (0.78±0.45 mm for Reader vs. 0.74±0.30 mm for AutoEdge). The symptomatic IMTV was about 11% higher than the asymptomatic IMTV when using Reader tracings and 8% higher when using AutoEdge. AutoEdge was very accurate in measuring the IMT and IMTV both for symptomatic and asymptomatic patients. Results showed that the symptomatic subjects had comparable IMT with respect to asymptomatic subjects, but a higher IMTV value.