A Hybrid Learning Algorithm for Breast Cancer Diagnosis

In many fields, particularly that of health, the diagnosis of diseases is a very difficult task to carry out. Therefore, early detection of diseases using artificial intelligence tools can be of paramount importance in the medical field. In this study, we proposed an intelligent system capable of performing diagnoses for radiologists. The support system is designed to evaluate mammographic images, thereby classifying normal and abnormal patients. The proposed method (DiagBC for Breast Cancer Diagnosis) combines two (2) intelligent unsupervised learning algorithms (the C-Means clustering algorithm and the Gaussian Mixture Model) for the segmentation of medical images and an algorithm for supervised learning (a modified DenseNet) for the diagnosis of breast images. Ultimately, a prototype of the proposed system was implemented for the Magori Polyclinic in Niamey (Niger) making it possible to diagnose (or classify) breast cancer into two (2) classes: the normal class and the abnormal class.

Convolutional Neural Network-Based Classificationof Multiple Retinal Diseases Using Fundus Images

Use of deep learning algorithms for the investigation and analysis of medical images has emerged as a powerful technique.The increase in retinal dis-eases is alarming as it may lead to permanent blindness if left untreated.Automa-tion of the diagnosis process of retinal diseases not only assists ophthalmologists in correct decision-making but saves time also.Several researchers have worked on automated retinal disease classification but restricted either to hand-crafted fea-ture selection or binary classification.This paper presents a deep learning-based approach for the automated classification of multiple retinal diseases using fundus images.For this research,the data has been collected and combined from three distinct sources.The images are preprocessed for enhancing the details.Six layers of the convolutional neural network(CNN)are used for the automated feature extraction and classification of 20 retinal diseases.It is observed that the results are reliant on the number of classes.For binary classification(healthy vs.unhealthy),up to 100%accuracy has been achieved.When 16 classes are used(treating stages of a disease as a single class),93.3%accuracy,92%sensitivity and 93%specificity have been obtained respectively.For 20 classes(treating stages of the disease as separate classes),the accuracy,sensitivity and specificity have dropped to 92.4%,92%and 92%respectively.

IMAGING DIAGNOSIS OF THORACOLUMBAR BURST FRACTURES

Objective To review imaging use in the diagnosis of thoracolumbar burst fractures and to determine the diagnostic va-lue of different imaging methods. Methods One hundred and fourteen patients with 120 thoracolumbar burst fractures were retrospectively reviewed. Pl-ain radiographs were available in all cases; CT scans and MRI were obtained in 96 and 74 cases, respectively. Results A total of 27 burst fractures were misdiagnosed as other types of fractures on radiographs alone, and accounted for 22.5% of all fractures. The results indicated that plain radiographs often fail to delineate the pathological features of thor-acolumbar burst fractures, leading to delay in diagnosis. Conclusion In regard to thoracolumbar injury diagnosis, burst fractures should be differentiated from compression frac-tures. CT should be routinely indicated and MRI examination, when necessary, may be simultaneously considered.

THE USEFULNESS OF ^(99)Tc-PMT DELAYED HEPATOBILIARY IMAGING IN THE DIAGNOSIS OF SMALL HEPATOCELLULAR CARCINOMA

This investigation was aimed to assess the usefulness of delayed hepalobillary Imaging in the diagnosis of small hepatocellular carcinoma (HCC). Sixty-two patients with this hepatic cancer were Included in the study. 56 males and 6 females, with a mean age of 50. 6 yr. (32 - 72 years old). All patients were performed by surgery, verified histologically, and these tumors were smaller than 5 cm. Liver scans were performed 5 minutes, 2 hours and 5 hours after the administration of radlopharmaceutices. In 31 of the 62 patients (50%), the tumor exhibited equal radioactivity uptake or greater radioactivity uptake than the surrounding liver in delayed imaging. And the sensitivity was 33. 3% (2/6), 41.2% (7/17), 60.0% (9/15) and 54.2% (13/24) In the tumor size was ≤2 cm, 2-3cm, 3-4 cm and 4 - 5 cm, respectively. The smallest mass to be detected was only 1. 2 cm. The uptake of radiopharmaceutic was nonsignificantly related to serum AFP level and hepatic cirrhosis (P>0. 05). These results show that 99-Tc-PMT delayed hepatobiliary imaging can be useful in the diagnosis of small hepatocellular carcinoma.

Imaging diagnosis and interventional radiology in systemic vasculitis with particular emphasis on Takayasu arteritis:Part 1

This is a review article describing some new and interesting aspects in the diagnosis and treatment in systemic vasculitis and demonstrating several cases that we have encountered.Particular emphasis will be put on Takayasu arteritis(also known as aortitis syndrome)most commonly observed in Japan and other oriental countries.CT and MRI better demonstrate the vessel wall abnormality of Takayasu arteritis than angiography.Importance of plain chest radiograph should also be kept in mind;it could provide a clue in the diagnosis of Takayasu arteritis in its early stage.

Measuring the density of the fissula antefenestram and the section of the basal turn of the cochlea:Are they useful in the radiological diagnosis of otosclerosis?

Introduction:The role of objective parameters in terms of improvement of the accuracy of highresolution computed tomography(HRCT)of the temporal bone in the diagnosis of otosclerosis remains unclear.Objectives:To investigate the relationship between the density of the fissula antefenestram(FAF)and of the width of the transversal section of the basal turn of the cochlea(BTC),and the diagnosis of otosclerosis.Methods:This is a retrospective study in which preoperative HRCT data from ears of patients submitted to stapedotomy due to otosclerosis(case group)were evaluated.For the control group,normal hearing ears having undergone HRCT for other purposes were included.Case and control HRCT images were objectively assessed by an experienced blinded radiologist.During this evaluation,measurements of the relative radiological density of the FAF and of the transversal section of the BTC were obtained.The results were compared between the groups.Also,a receiver operating characteristic curve was created and the area under the curve(AUC)was calculated for each variable.Significance level was set at.05.Results:40 ears were included in each group.Case ears presented reduced values for the relative radiological density on the FAF(p-value<0.0001).Moreover,ears with otosclerosis(p-value:0.022)presented lower transversal section of the BTC.The AUC for these variables reached 0.929 and 0.646,respectively.Conclusions:Otosclerotic ears present reduced radiological density on the FAF and narrower BTC.The relative density of the FAF also shows a great diagnostic power in the context of this disease.

COMBINED IMAGING DIAGNOSIS OF PAROTID MASSES

Computed tomography (CT), ultrasonography, sialography, and 99mTc scintigraphy were applied before operation to 108 patients with parotid masses. The results of each technique and the combined study of them were compared with the pathological diagnosis. Ultrasonography was found to be a very effective diagnostic aid in determining the presence of space-occupying lesion in the parotid. CT was the best technique to provide adequately reliable informations regarding the location of the tumor and the relationship between tumor and surrounding tissues. For diagnosing the nature of tumors, ultrasonography combined with sialography was reliable. 99mTc scintigraphy was better than other techniques in diagnosis of adenolymphoma. The diagnostic accuracy of combined diagnosis (90.7%) was higher than those of ultrasonography (83%), CT (80.5%), sialography (79%), and 99mTc scintigraphy (13.9%) alone. The advantage of combined diagnosis was particularly obvious for the diagnosis of low-grade malignant tumors.

RADIONUCLIDE WHOLE BODY BONE IMAGING IN THE DIAGNOSIS OF SKELETAL METASTASES

Of 628 patients with extra-osseous malignancies diagnosed by surgery and/or pathology, 207 (33.0%) were identified as having skeletal metastasis by bone imaging. There was statistical significant difference in the incidence of metastasis in different malignancies (P<0.02). The metastatic rates of nasopharyn-geal, lung, prostate and breast cancers were higher than gastrointestinal, kidney, and other malignancies. There was significant differences in the different sites of skeletal metastasis (P<0.01). They were thorax, spine, pelvis, limbs and skull in order of incidence. Solitary metastatic rate was 15.9%. Biopsy is advised for patients suspected to have metastatic disease but with only one single 'hot spot' in skeletal imaging, particularly in the rib.

Thermographic Diagnosis for Curative Effect of Acupuncture and Qi-gong

Thermographic technique can be used to measure temperature distribution of bo d y surface in real-time, non-contact and full-field, which has been successful ly used in medical diagnosis, remote sensing, and NDT, etc. The authors have develo ped a thermographic experiment that can be applied to inspect the effect of acti on of acupuncture and qi-gong (a system of deep breathing exercises) by measuri n g the temperature of hand and arm. The observation is performed respectively by thermography for the dynamic changes of temperature of the arm and hand after ac upuncture treatment and qi-gong treatment. Thermographic results show that the t emperature on the collateral channels increases significantly. In the meantime, it can be seen that the above therapies of traditional Chinese medicine can stim ulate the channel collateral system. This also contributes a new basis to the ef fect of action of the therapies of traditional Chinese medicine. The work shows that thermographic technique is a powerful tool for research in traditional Chin ese medicine. In this paper, some thermal images are obtained from the persons t reated with acupuncture and qi-gong.

Superior Vana Cava Syndrome: A Therapy by Intra-vascular Stenting

Objective To study the techniques and clinical applications of intra-vascular stenting in the treatment of superior vana cava obliteration syndrome (SVS). Methods In 9 cases of SVS, primary lesions were all confirmed as malignancy (primary pulmonary carcinoma of right upper lobe) histolo-pathologically. By route of right femoral vein, SVS catheterization and DSA was made. The length of the strictures and the diameters of normal superior vana cavae (SVC) were measured for the choice of appropriate stents. The option of stemt diameter is 10% larger than that of normal SVCs. The upper and lower ends of the stent should be 1–2 cm protruding from the ends of the stricture. The stent was dilated with a balloon after its successful placement. Therapy of original lesions was continued together with anticoagulant. Stents were observed about their positions by fluoroscopy or chest films, and about patency of SVC by Doppler. Results After the placement of a stent, DSA revealed the contrast media in the SVCs passed along smoothly, diameters of SVCs almost normal, collateral branches diminished remarkably. Average SVC pressure was decreased from 26.4 cmH2O before the placement down to 15.7 cmH2O, with an obvious difference (P<0.01= by statistics. Related clinical symptoms and signs disappeared or relieved. Subsidised were swelling of head and neck, upper extremities and chest. Excretion of urine increased. Gorgeous superficial veins in the chest could not be detected any more. Conclusion The therapy of intra-vascular stenting to treat SVS is microinvasive, simple and effective. Key words superior vana cava syndrome - tumor - stent - image diagnosis - interventional therapy

肺动脉血栓栓塞的影像诊断新进展及介入治疗研究

肺栓塞的影像学诊断方法多样,但不同的影像学表现特点和诊断的准确性影响了临床医生的选择。同时介入治疗原理及介入治疗适应证的选择对治疗结果有着很大的影响。本文对肺栓塞的影像学诊断及介入治疗的方法作一综述。

Magnetic resonance imaging of portal vein invasion in hepatocellular carcinoma:A corroboration of 25 cases

AIMS Pre-operatively to assess tumor thrombus as- sociated with hepatocellular carcinoma in the portal vein. METHEDS Twenty-five patients diagnosed as hav- ing thrombus due to hepatocellular carcinoma were corroborated. MR imaging was perfomed with a 1.0T superconducting magnetic system. Both T1 and T2 weighed images and FLASH sequences were obtained in transverse plane. Additional FLASH images were ob- tained in coronal plane. RESULTS Thrombus in portal vein had a signal in- tensity similar to that of the main tumors. Intrinsic por- tal vein thrombus was in 16 patients. Six cases showed occlusive thrombus. Diffusely narrow portal branches were found in 3 patients. Portal venous thrombus showed an area of signal intensity which was replacing the normal flow void in the portal vein and showed a stumpy portal vein,irregular stenosis of portal vein and the formation of vascular net. CONCLUSION MRI was more sensitive and specific and a noninvasive method in detection of portal tumor thrombus used jointly with spin ech (SE) and gradient echo (GRE) techniques.

Artificial intelligence in gastrointestinal radiology: A review with special focus on recent development of magnetic resonance and computed tomography

Artificial intelligence(AI),particularly the deep learning technology,have been proven influential to radiology in the recent decade.Its ability in image classification,segmentation,detection and reconstruction tasks have substantially assisted diagnostic radiology,and has even been viewed as having the potential to perform better than radiologists in some tasks.Gastrointestinal radiology,an important subspecialty dealing with complex anatomy and various modalities including endoscopy,have especially attracted the attention of AI researchers and engineers worldwide.Consequently,recently many tools have been developed for lesion detection and image construction in gastrointestinal radiology,particularly in the fields for which public databases are available,such as diagnostic abdominal magnetic resonance imaging(MRI)and computed tomography(CT).This review will provide a framework for understanding recent advancements of AI in gastrointestinal radiology,with a special focus on hepatic and pancreatobiliary diagnostic radiology with MRI and CT.For fields where AI is less developed,this review will also explain the difficulty in AI model training and possible strategies to overcome the technical issues.The authors’insights of possible future development will be addressed in the last section.

Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease

The coexistence of thyroid diseases with primary hyperparathyroidism (PHPT) can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study. Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision (about 3 cm), while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter (32.7%), 2 thyroiditis (3.8%), 2 thyroid adenoma (3.8%) and 1 thyroid carcinoma (1.9%) coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultra-sonography (US) and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography (CT) and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of asso-ciated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.

Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features

Far lateral lumbar disc herniations(FLLDH)represent a separate category of disc pathology which includes both intraforaminal and extraforaminal lumbar disc herniations,that are characterized by a peculiar clinical presentation,diagnostic and treatment modalities as compared to the more frequent median and paramedian disc hernias.Surgical treatment often represents the only effective weapon for the cure of this disease and over the years different approaches have been developed that can reach the region of the foramen or external to it,with different degrees of invasiveness.The diagnosis is more demanding and still underestimated as it requires a more detailed knowledge in the spine anatomy and dedicated radiological studies.Computerized tomography and in particular magnetic resonance imaging are the appropriate tools for the diagnosis of FLLDH.Despite the widespread use of these diagnostic tests,many cases of FLLDH are overlooked due to insufficiently detailed radiological examinations or due to the execution of exams not focused to the foraminal or the extraforaminal region.Neurophysiological studies represent a valid aid in the diagnostic classification of this pathology and in some cases they can facilitate the differential diagnosis with other types of radiculopathies.In the present study,a comprehensive review of the clinical presentation,epidemiology,radiological study and the neurophysiological aspects is presented.

Review of Budd-Chiari Syndrome

This study aims to report the Budd-Chiari syndrome clinical research status and progress that has occurred in over nearly 30 years in China, and emphasize the value of imaging in facilitating the diagnosis of Budd-Chiari syndrome based on more than 2500 cases. Findings on ultrasonography, computed tomography, magnetic resonance imaging, and digital subtraction angiography images are used to propose new Budd-Chiari syndrome types and subtypes. The new subtype classification presented here has important value for guiding interventional treatment.This study also proposes a new concept of anatomical and functional obstruction of hepatic vein that stresses the compensatory value of accessory hepatic vein and azygos vein and describes the risk of manipulation of the communication branch of inferior vena cava obstruction in interventional therapy.

Pancreatic carcinoma coexisting with chronic pancreatitis versus tumor-forming pancreatitis:Diagnostic utility of the time-signal intensity curve from dynamic contrast-enhanced MR imaging

AIM: To evaluate the ability of the time-signal intensity curve (TIC) of the pancreas obtained from dynamic contrast-enhanced magnetic resonance imaging (MRI) for differentiation of focal pancreatic masses, especially pancreatic carcinoma coexisting with chronic pancreatitis and tumor-forming pancreatitis. METHODS: Forty-eight consecutive patients who underwent surgery for a focal pancreatic mass, including pancreatic ductal carcinoma (n = 33), tumor-forming pancreatitis (n = 8), and islet cell tumor (n = 7), were reviewed. Five pancreatic carcinomas coexisted with longstanding chronic pancreatitis. The pancreatic TICs were obtained from the pancreatic mass and the pancreatic parenchyma both proximal and distal to the mass lesion in each patient, prior to surgery, and were classified into 4 types according to the time to a peak: 25 s and 1, 2, and 3 min after the bolus injection of contrast material, namely, type-Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively, and were then compared to the corresponding histological pancreatic conditions. RESULTS: Pancreatic carcinomas demonstrated type-Ⅲ (n = 13) or Ⅳ (n = 20) TIC. Tumor-forming pancreatitis showed type-Ⅱ (n = 5) or Ⅲ (n = 3) TIC. All islet cell tumors revealed type-Ⅰ. The type-Ⅳ TIC was only recognized in pancreatic carcinoma, and the TIC of carcinoma always depicted the slowest rise to a peak among the 3 pancreatic TICs measured in each patient, even in patients with chronic pancreatitis.CONCLUSION: Pancreatic TIC from dynamic MRI provides reliable information for distinguishing pancreatic carcinoma from other pancreatic masses, and may enable us to avoid unnecessary pancreatic surgery and delays in making a correct diagnosis of pancreatic carcinoma, especially, in patients with longstanding chronic pancreatitis.

COMPARISON OF INFRARED LIGHTSCANNING AND MAMMOGRAPHY IN BREAST CANCER DETECTION

Purpose: This study is in an attempt to assess the diagnostic accuracy of infrared lightscanning by comparing with that of mammograpby- Methods: A total of 104 patients had been examined by both mammography and infrared lightscanning before surgery.All Patients were divided into two groups: cancer and non cancer. The diagnostic accuracy of these two modalities were calculated. Results: Of 104 Patients, 43 had breast cancer and 61 had benign lesions, the sensitivity and specificity for mammography were 84% and 83%, 82% and 77% for infrared lightscanning. The predictive values of positivity for mammograpby and lightscanning were 80% and 70%, the negative Predictive value for these two modalities were both 87%. Conclusion: Infrared lightscanning,being of assistance to mammography, could enhance sensitivity and predictive values of positivity in detecting breast cancer, especially, in mammographically dense breast.

THE MAMMOGRAPHIC CALCIFICATIONS IN BREAST CANCER

Objective: This study was performed to exam the relativeship between mammographic calcifications and breast cancer. Methods: All of the 184 patients with breast diseases underwent mammography before either an open biopsy or a mastectomy. The presence, morphology, and distribution of calcifications visualized on mammograms for breast cancer were compared with the controls who remained cancer free. Statistical comparisons were made by using the x 2 test. Results: Of the 184 patients with breast diaeases, 93 malignant and 91 benign lesions were histologically confirmed. Calcifications were visualized on mammograms in 60 (64%)of 93 breast cancers and 26(28%)of 91 non breast cancers. The estimated odds ratio (OR) of breast cancer was 4.5 in women with calcifications seen on mammo grams, compared with those having none ( P < 0.01). Of the 60 breast carcinomas having mammographic calcifi cations, 28 (47%) were infiltrating ductal carcinomas. There were only 8 (24%) cases with infiltrating ductal cancers in the group of without calcifications seen on the mammograms ( P <0.05). Conclusion: Our finding sug gests that mammographic calcification appears to be a risk factor for breast cancer. The granular and linear cast type calcification provide clues to the presence of breast cancer, especially when the carcinomas without associated masses were seen on mammograms.

Clear Cell Myo-Melanomas of Ligamentum Teres Hepatis: A Case Report and Literature Review

Introduction: Clear Cell Myomelanocytic Tumor (CCMMT) of ligamentum teres hepatis is a pathological classification of Perivascular Epithelioid Cell tumor (PEComa), which is rare clinically and easy to misdiagnose. Objective: To report a case of a rare type of PEComa located in the ligamentum teres hepatis. Case Report: A 22-year-old Asian female was diagnosed with abdominal mass during physical examination in September 2018, and was admitted to the general surgery department of our hospital that month. She was diagnosed with abdominal mass, the nature of which remains to be determined is: teratoma, pheochromocytoma or ganglioma. At the time of admission, the patient had no symptoms or signs, and no other medical history. The patient was diagnosed with an abdominal mass by abdominal plain scan and enhanced CT, whose nature was to be determined: pheochromocytoma, paragangliomas or other mesenchymal tumors, or giant lymph node hyperplasia. The patient underwent abdominal mass resection and appendectomy without incident, without any complications at discharge, and there was no significant difference in follow-up. Conclusions: The clinical data, imaging features and pathological features of one patient diagnosed with CCMMT in our hospital were retrospectively analyzed, and the literature was reviewed in combination with the research progress of CCMMT, in order to improve the understanding and diagnostic accuracy of this disease.