The effect of deep convolutional neural networks on radiologists' performance in the detection of hip fractures on digital pelvic radiographs

PURPOSE

The purpose of our study is to develop deep convolutional neural network (DCNN) for detecting hip fractures using CT and MRI as a gold standard, and to evaluate the diagnostic performance of 7 readers with and without DCNN.

METHODS

The study population consisted of 327 patients who underwent pelvic CT or MRI and were diagnosed with proximal femoral fractures. All radiographs were manually checked and annotated by radiologists referring to CT and MRI for selecting ROI. At first, a DCNN with the GoogLeNet model was trained by 302 cases. The remaining 25 cases and 25 control subjects were used for the observer performance study and for the testing of DCNN. Seven readers took part in this study. A continuous rating scale was used to record each observer's confidence level. Subsequently, each observer interpreted with the DCNN outputs and rated them again. The area under the curve (AUC) was used to compare the fracture detection.

RESULTS

The average AUC of the 7 readers was 0.832. The AUC of DCNN alone was 0.905. The average AUC of the 7 readers with DCNN outputs was 0.876. The AUC of readers with DCNN output were higher than those without(p < 0.05). The AUC of the 2 experienced readers with DCNN output exceeded the AUC of DCNN alone.

CONCLUSION

For detecting the hip fractures on radiographs, DCNN developed using CT and MRI as a gold standard by radiologists improved the diagnostic performance including the experienced readers.

Platelet-activating factor-induced intracellular calcium waves in human uterine myometrial cells

OBJECTIVE

We visualized and investigated the intracellular calcium waves propagated by platelet-activating factor (PAF) in cultured human myometrial cells.

STUDY DESIGN

Myometrial cells were stimulated with PAF ranging between 10(-8) and 10(-15) M. For the observation of calcium waves, calcium green-1 and a confocal laser microscopy were used. Cells were also stimulated with 10(-9) M of PAF in a calcium-free solution.

RESULTS

In physiological solution, PAF at concentrations ranging between 10(-9) and 10(-15) M induced intracellular calcium waves. Mean wave speed was 16.1+/-5.6 microm/s. Wave speeds were independent of the PAF concentration. Similar results were observed in the absence of added calcium, with the exception that the wave speeds were significantly slower (7.3+/-3.3 microm/s). CONCLUSIONS This is the first study to demonstrate the calcium waves propagated by PAF stimulation in human myometrial cells. These observations further support the proposed role of PAF in parturition.

Feasibility of Breath-Hold Zero TE Magnetic Resonance Imaging Sequence for Evaluation of Pulmonary Arteriovenous Malformations After Embolotherapy

ABSTRACT

We obtained breath-hold zero TE (ZTE) magnetic resonance imaging for the evaluation of pulmonary arteriovenous malformations before and after embolotherapy. To the best of our knowledge, there have been no reports of ZTE for the entire lung imaging in single breath-hold scan time such as 20 seconds. Breath-hold ZTE magnetic resonance imaging can be a useful technique for magnetic resonance-based follow-up of vascular lung diseases without using contrast media, reducing the undesired artifacts from metallic devices.

Intraperitoneal Bleeding Induced by a Ruptured Inferior Epigastric Artery Pseudoaneurysm following Interval Debulking Surgery for Ovarian Cancer: A Case Report

Introduction

Pseudoaneurysm following gynecologic cancer surgery is a rare complication that can become fatal when it ruptures. Common sites of pseudoaneurysms are the external iliac artery, hypogastric artery, and aorta, which are located around the lymphadenectomy site. There are no previous reports of ruptured inferior epigastric (IEA) artery pseudoaneurysms after gynecologic cancer surgery. We report a case of intraperitoneal bleeding induced by a ruptured IEA pseudoaneurysm following interval debulking surgery for stage IVB ovarian cancer.

Case Presentation

The patient underwent total abdominal simple hysterectomy, bilateral salpingo-oophorectomy, omentectomy, ileocolic resection, and peritonectomy around the ileocecal area after 5 cycles of neoadjuvant chemotherapy. The patient suddenly presented with loss of consciousness and reduced blood pressure on postoperative day 20. Her blood hemoglobin levels also decreased. Contrast-enhanced computed tomography revealed a pseudoaneurysm in the right IEA. There were no signs of extravasation from the pseudoaneurysm; however, bloody ascites was observed in the abdominal cavity. A ruptured IEA pseudoaneurysm was suspected, and coil embolization was immediately performed. Her symptoms abated soon after coil embolization, and she remained symptom-free during the 8 months of postoperative follow-up.

Conclusion

Awareness of this rare complication is clinically important for its early detection and treatment.

Immunohistochemical localization of polo like kinase in early human placenta

Polo like kinase (PLK) is the kinase that was first cloned by us from the cDNA library of human placenta. It belongs to the serine/threonine kinase family and plays a very important role in cell proliferation. In this study, the localization of PLK in early human placenta in vivo was investigated. Immunostaining revealed PLK protein in syncytiotrophoblastic cells and extravillous trophoblastic cells; however proliferating cell nuclear antigen was not. It is known that cytotrophoblastic cells proliferate highly in early human placental villi; however, PLK was not detected in those cells. These results suggest that PLK plays a different role in syncytiotrophoblastic cells than it does in other proliferating cells.

Zero Echo Time Magnetic Resonance Imaging; Techniques and Clinical Utility in Musculoskeletal System

Zero echo time (ZTE) sequence is recent advanced magnetic resonance technique that utilizes ultrafast readouts to capture signals from short-T2 tissues. This sequence enables T2- and T2* weighted imaging of tissues with short intrinsic relaxation times by using an extremely short TE, and are increasingly used in the musculoskeletal system. We review the imaging physics of these sequences, practical limitations, and image reconstruction, and then discuss the clinical utilities in various disorders of the musculoskeletal system. ZTE can be readily incorporated into the clinical workflow, and is a promising technique to avoid unnecessary radiation exposure, cost, and time-consuming by computed tomography in some cases. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 1.

1182 THE PREVALENCE OF ORAL FRAILTY AND ITS ASSOCIATION WITH DYSPHAGIA, FRAILTY AND FORMAL CARE NEEDS

Introduction

Oral frailty (OF), gradual loss of oral function combined associated with presbyphagia often in conjunction with cognitive and physical decline, has been recommended to be considered as a geriatric giant. DENTAL has been suggested as a possible screening tool for OF. We have looked at the prevalence of OF and its association with dysphagia, frailty and formal care, amongst people admitted acutely to the acute medical/frailty wards in our hospital.

Methods

OF, dysphagia and frailty were screened for as part of the routine clinical assessment of patients during the usual clinical ward round. Screening tools used were DENTAL for OF, Rockwood Score for frailty and 4QT for dysphagia. Age, sex comorbidities and the need for formal care was documented.

Results

101 people were assessed over a 4-week period. Mean age was 84 years (65-99), 58 (57.4%) were female, 31(30.7%) were independent, 33 (32.6%) dementia, 57 (56.4%) frail, 54 (53.4%) had swallowing problems, and 34 (33.6%) OF. Of those with OF 97% had dysphagia, 88% were frail and 85% required formal care support (85%). OF was associated with dysphagia (p&lt;0.0001), frailty (p&lt; 0.0001), formal care support (p&lt;0.05) and dementia (p&lt;0.05). There was an association between needing care and frailty (p&lt;0.01).

Conclusions

OF is associated with dysphagia, frailty and the need for formal care. OF may result in poor oral health and contribute to dysphagia and frailty, conversely frailty and dysphagia may result in poor oral health due to dependency and poor nutrition and dehydration. The associations are most likely be bidirectional. Further work is required to elucidate this. Clinical staff need to be aware of OF and oral health and include oral screening in their clinical assessment of an older adult.

Usefulness of Olfactory Bulb Measurement in 3D-FIESTA in Differentiating Parkinson Disease from Atypical Parkinsonism

BACKGROUND AND PURPOSE

Parkinson disease is a prevalent disease, with olfactory dysfunction recognized as an early nonmotor manifestation. It is sometimes difficult to differentiate Parkinson disease from atypical parkinsonism using conventional MR imaging and motor symptoms. It is also known that olfactory loss occurs to a lesser extent or is absent in atypical parkinsonism. To the best of our knowledge, no study has examined olfactory bulb changes to differentiate Parkinson disease from atypical parkinsonism, even in an early diagnosis, and its association with conventional MR imaging findings. Hence, we aimed to assess the utility of olfactory bulb measurements in differentiating Parkinson disease from atypical parkinsonism even in the early stage.

MATERIALS AND METHODS

In this retrospective study, we enrolled 108 patients with Parkinson disease, 13 with corticobasal syndrome, 15 with multiple system atrophy, and 17 with progressive supranuclear palsy who developed parkinsonism. Thirty-nine age-matched healthy subjects served as controls. All subjects underwent conventional MR imaging and 3D FIESTA for olfactory bulb measurements using manual ROI quantification of the cross-sectional olfactory bulb area using the coronal plane. Bilateral olfactory bulb measurements were averaged. For group comparisons, we used the Welch t test, and we assessed diagnostic accuracy using receiver operating characteristic analysis.

RESULTS

Patients with Parkinson disease had a mean olfactory bulb area of 4.2 (SD, 1.0 mm2), significantly smaller than in age-matched healthy subjects (6.6 [SD, 1.7 mm2], P < .001), and those with corticobasal syndrome (5.4 [SD, 1.2 mm2], P < .001), multiple system atrophy (6.5 [SD, 1.2 mm2], P < .001), and progressive supranuclear palsy (5.4 [SD, 1.2 mm2], P < .001). The receiver operating characteristic analysis for the olfactory bulb area measurements showed good diagnostic performance in differentiating Parkinson disease from atypical parkinsonism, with an area under the curve of 0.87, an optimal cutoff value of 5.1 mm2, and a false-positive rate of 18%. When we compared within 2 years of symptom onset, the olfactory bulb in Parkinson disease (4.2 [SD, 1.1 mm2]) remained significantly smaller than in atypical parkinsonism (versus corticobasal syndrome (6.1 [SD, 0.7 mm2]), P < .001; multiple system atrophy (6.3 [SD, 1.4 mm2]), P < .001; and progressive supranuclear palsy (5.2 [1.3 mm2], P = .003, respectively).

CONCLUSIONS

3D FIESTA-based olfactory bulb measurement holds promise for distinguishing Parkinson disease from atypical parkinsonism, especially in the early stage.