Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques

Effective prevention and management of osteoporosis would require suitable methods for population screenings and early diagnosis. Current clinicallyavailable diagnostic methods are mainly based on the use of either X-rays or ultrasound(US). All X-ray based methods provide a measure of bone mineral density(BMD), but it has been demonstrated that other structural aspects of the bone are important in determining fracture risk, such as mechanical features and elastic properties, which cannot be assessed using densitometric techniques. Among the most commonly used techniques, dual X-ray absorptiometry(DXA) is considered the current 'gold standard' for osteoporosis diagnosis and fracture risk prediction. Unfortunately, as other X-ray based techniques, DXA has specific limitations(e.g., use of ionizing radiation, large size of the equipment, high costs, limited availability) that hinder its application for population screenings and primary care diagnosis. This has resulted in an increasing interest in developing reliable pre-screening tools for osteoporosis such as quantitative ultrasound(QUS) scanners, which do not involve ionizing radiation exposure and represent a cheaper solution exploiting portable and widely available devices. Furthermore, the usefulness of QUS techniques in fracture risk prediction has been proven and, with the last developments, they are also becoming a more and more reliable approach for assessing bone quality. However, the US assessment of osteoporosis is currently used only as a pre-screening tool, requiring a subsequent diagnosis confirmation by means of a DXA evaluation. Here we illustrate the state of art in the early diagnosis of this 'silent disease' and show up recent advances for its prevention and improved management through early diagnosis.

Comparing upper gastrointestinal X-ray and endoscopy for gastric cancer diagnosis in Korea

AIM:To compare the cost and accuracy of upper gastrointestinal(GI)X-ray and upper endoscopy for diagnosis of gastric cancer using data from the 2002-2004 Korean National Cancer Screening Program(NCSP). METHODS:The study population included 1 503 646 participants in the 2002-2004 stomach cancer screening program who underwent upper GI X-ray or endoscopy.The accuracy of screening was defined as the probability of detecting gastric cancer.We calculated the probability by merging data from the NCSP and the Korea Central Cancer Registry.We estimated the direct costs of the medical examination and the tests for up- per GI X-ray,upper endoscopy,and biopsy. RESULTS:The probability of detecting gastric cancervia upper endoscopy was 2.9-fold higher than via upper GI X-ray.The unit costs of screening using upper GI X-ray and upper endoscopy were$32.67 and$34.89, respectively.In 2008,the estimated cost of identifying one case of gastric cancer was$53094.64 using upper GI X-ray and$16 900.43 using upper endoscopy.The cost to detect one case of gastric cancer was the same for upper GI X-ray and upper endoscopy at a cost ratio of 1:3.7. CONCLUSION:Upper endoscopy is slightly more costly to perform,but the cost to detect one case of gastric cancer is lower.

Bone and soft tissue tumors presenting as sciatic notch dumbbell masses: A critical differential diagnosis of sciatica

AIM To study the clinical findings and characteristic features in sciatic notch dumbbell tumors(SNDTs).METHODS We retrospectively reviewed the clinical outcomes and characteristic features of consecutive cases of SNDTs(n = 8). RESULTS Buttock masses occurred in three patients with SNDT(37.5%). Severe buttock tenderness and pain at rest were observed in seven patients with SNDTs(87.5%). Remarkably, none of the patients with SNDTs experienced back pain. Mean tumor size was 8.4 ± 2.0 cm(range, 3.9 to 10.6 cm) and part of the tumor mass was detected in 2 patients in the sagittal view of lumbar magnetic resonance imaging(MRI).CONCLUSION The clinical information regarding to SNDTs is scarce. The authors consider that above mentioned characteristic findings may facilitate the suspicion of pelvic pathology and a search for SNDT by MRI or computed tomography should be considered in patients presenting with sciatica without evidence of spinal diseases.

Molecularly specific detection of bacterial lipoteichoic acid for diagnosis of prosthetic joint infection of the bone

Discriminating sterile inflammation from infection, especially in cases of aseptic loosening versus an actual prosthetic joint infection, is challenging and has significant treatment implications. Our goal was to evaluate a novel human monoclonal antibody（mAb） probe directed against the Gram-positive bacterial surface molecule lipoteichoic acid（LTA）. Specificity and affinity were assessed in vitro. We then radiolabeled the anti-LTA mAb and evaluated its effectiveness as a diagnostic imaging tool for detecting infection via immuno PET imaging in an in vivo mouse model of prosthetic joint infection（PJI）. In vitro and ex vivo binding of the anti-LTA mAb to pathogenic bacteria was measured with Octet, ELISA, and flow cytometry. The in vivo PJI mouse model was assessed using traditional imaging modalities, including positron emission tomography（PET） with [^（18）F]FDG and [^（18）F]Na F as well as X-ray computed tomography（CT）, before being evaluated with the zirconium-89-labeled antibody specific for LTA（[^（89）Zr]SAC55）.The anti-LTA mAb exhibited specific binding in vitro to LTA-expressing bacteria. Results from imaging showed that our model could reliably simulate infection at the surgical site by bioluminescent imaging, conventional PET tracer imaging, and bone morphological changes by CT. One day following injection of both the radiolabeled anti-LTA and isotype control antibodies, the anti-LTA antibody demonstrated significantly greater（P 〈 0.05） uptake at S. aureus-infected prosthesis sites over either the same antibody at sterile prosthesis sites or of control non-specific antibody at infected prosthesis sites. Taken together, the radiolabeled anti-LTA mAb, [^（89）Zr]SAC55, may serve as a valuable diagnostic molecular imaging probe to help distinguish between sterile inflammation and infection in the setting of PJI. Future studies are needed to determine whether these findings will translate to human PJI.

Primary Lymphoma of Bone: Imaging Findings to Improve Diagnosis of a Rarely Considered Disease Prior to Biopsy

Objective: Primary lymphoma of bone (PLB) is a rare malignant bone tumor often presenting in the fifth-sixth decades involving appendicular long bones. Published radiological findings indicate that PLB typically presents as a moth-eaten osteolytic lesion with periosteal reaction, while MRI commonly demonstrates marrow infiltration with extraosseous extension. Given rarity and variable appearances, PLB may not be primarily considered prior to biopsy. Our objective was to evaluate preoperative imaging findings in effort to increase awareness and improve a perceived deficiency in preoperative diagnosis. Materials and Methods: Following IRB approval, retrospective review identified 60 patients with newly diagnosed bone lesions proven to represent PLB in accordance with WHO definition. Preoperative radiographs (n = 46), MRI (n = 33) and PET (n = 37) were independently reviewed by two radiologists. At radiography, lesions were classified: purely lytic, mixed, purely sclerotic, or occult;lytic lesions were graded utilizing Lodwick’s classification. At MRI, lesions were defined as focal or infiltrative and the presence or absence of extraosseous disease was recorded. Extraosseous masses were defined as small (1 cm) and subjectively correlated with degree of cortical destruction. At PET, lesions were recorded as FDG-avid or not. Primary radiograph reports when available (n = 33) were reviewed and exact wording of differential considerations was recorded. Results: Radiographs demonstrated mixed (n = 22), lytic (n = 15), and sclerotic (n = 8) appearances;one radiographically occult lesion was seen by MRI. Lytic lesions were graded: IB (n = 3), IC (n = 5), II (n = 4), and III (n = 3);none were IA. At MRI, 30 lesions were infiltrative and 3 were focal;11 were not associated with extraosseous extension, while 22 showed bony disease with small (n = 7) or large (n = 15) soft tissue mass. Of large masses, 13 demonstrated minimal cortical destruction. At PET, 36 demonstrated FDG uptake;one study was technically limited. Review of reports found that only 5 included “lymphoma” as a diagnostic consideration. Conclusion: Contrary to most published data, we suggest that PLB typically demonstrates some degree of osteosclerosis, often a mixed pattern of sclerosis and lucency;purely lytic lesions may be less common. Similar to existing reports, MRI commonly demonstrates marrow infiltration with extraosseous extension of disease, typically a large soft tissue mass with disproportionate (minimal) cortical destruction. Familiarity with these findings should improve preoperative consideration of PLB in the appropriate clinical scenario when a new osteoblastic lesion is identified.

Understanding Osteoporosis: Pathophysiology, Risk Factors, Diagnosis, and Management

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and deterioration of bone architecture, resulting in reduced bone strength and, consequently, increased susceptibility to fractures which poses a significant public health concern worldwide, particularly in aging populations [1]. The health-economic impact of vertebral and hip fractures has been extensively explored and it is well known that these fractures are associated with morbidity/disability and increased mortality;they also account for a substantial portion of the direct fracture costs. This review aims to provide a comprehensive overview of osteoporosis, including its pathophysiology, risk factors, diagnostic approaches, and management strategies. By elucidating the multifaceted nature of this condition, healthcare providers can better identify individuals at risk, implement preventive measures, and optimize treatment to reduce the burden of osteoporotic fractures.

A Comprehensive Investigation of Machine Learning Feature Extraction and ClassificationMethods for Automated Diagnosis of COVID-19 Based on X-ray Images

The quick spread of the CoronavirusDisease(COVID-19)infection around the world considered a real danger for global health.The biological structure and symptoms of COVID-19 are similar to other viral chest maladies,which makes it challenging and a big issue to improve approaches for efficient identification of COVID-19 disease.In this study,an automatic prediction of COVID-19 identification is proposed to automatically discriminate between healthy and COVID-19 infected subjects in X-ray images using two successful moderns are traditional machine learning methods(e.g.,artificial neural network(ANN),support vector machine(SVM),linear kernel and radial basis function(RBF),k-nearest neighbor(k-NN),Decision Tree(DT),andCN2 rule inducer techniques)and deep learningmodels(e.g.,MobileNets V2,ResNet50,GoogleNet,DarkNet andXception).A largeX-ray dataset has been created and developed,namely the COVID-19 vs.Normal(400 healthy cases,and 400 COVID cases).To the best of our knowledge,it is currently the largest publicly accessible COVID-19 dataset with the largest number of X-ray images of confirmed COVID-19 infection cases.Based on the results obtained from the experiments,it can be concluded that all the models performed well,deep learning models had achieved the optimum accuracy of 98.8%in ResNet50 model.In comparison,in traditional machine learning techniques, the SVM demonstrated the best result for an accuracy of 95% and RBFaccuracy 94% for the prediction of coronavirus disease 2019.

Exploratory Application of X-ray Photography in the Diagnosis of Poultry Fatty Liver

[Objectives]This study was conducted to explore the application value of X ray in the diagnosis of poultry fatty liver.[Methods]Serum biochemical tests were performed on laying hens with suspected fatty liver.The X-ray liver images of the left lateral position were observed.And the liver traits were observed by anatomy.[Results]The increase in liver space occupying lesion observed by X-ray photography was consistent with the increase in liver volume observed by anatomy.The biochemical test showed slight liver function abnormalities.[Conclusions]X-ray examination can be used for the auxiliary diagnosis of poultry fatty liver.

Anisotropy of Trabecular Bone from Ultra-Distal Radius Digital X-Ray Imaging: Effects on Bone Mineral Density and Age

Background: When applied to trabecular bone X-ray images, the anisotropic properties of trabeculae located at ultra-distal radius were investigated by using the trabecular bone scores (TBS) calculated along directions parallel and perpendicular to the forearm. Methodology: Data from more than two hundred subjects were studied retrospectively. A DXA (GE Lunar Prodigy) scan of the forearm was performed on each subject to measure the bone mineral density (BMD) value at the location of ultra-distal radius, and an X-ray digital image of the same forearm was taken on the same day. The values of trabecular bone score along the direction perpendicular to the forearm, TBSx, and along the direction parallel to the forearm, TBSy, were calculated respectively. The statistics of TBSx and TBSy were calculated, and the anisotropy of the trabecular bone, which was defined as the ratio of TBSy to TBSx and changed with subjects’ BMD and age, was reported and analyzed. Results: The results show that the correlation coefficient between TBSx and TBSy was 0.72 (p BMD and age was reported. The results showed that decreased trabecular bone anisotropy was associated with deceased BMD and increased age in the subject group. Conclusions: This study shows that decreased trabecular bone anisotropy was associated with decreased BMD and increased age.

Broken Rotor Bar Fault Diagnosis of Induction Motors Using a Hybrid Bare-bones Particle Swarm Optimization Algorithm

在传统定子电流频谱分析中,感应电机转子断条故障特征经常被基波分量淹没而无法准确检测。针对该问题,提出一种基于混合骨干微粒群优化算法的转子断条故障诊断新方法。该方法首先根据电流信号与单位余弦基函数的内积最大准则,利用混合骨干微粒群算法强大的全局搜索能力,准确估计出基波波形参数;然后利用波形参数构造出基波表达式,并将其从原电流信号中剔除,达到突出故障特征的目的。针对微粒群算法在进化后期收敛缓慢的缺点,通过K–均值聚类方式,引入单纯形法对其进行改进,使整个算法的广度探索与深度开发能力得到了有效均衡。最后,对模拟数据和实测信号进行实验,结果验证了所提方法的有效性和优越性。

Adamantinoma of the pelvic bone, a difficult diagnosis with fatal outcome

Adamantinoma is a primary low grade malignant bone tumor that is predominantly located in the mid-portion of the tibia. The tumor is of interest for two reasons： first, there still exists considerable dispute as to the origin of the lesion and recent reports reveal that the condition is more malignant than had previously been supposed. Although cases of adamanti- noma located to the axial skeleton have been reported, this is the first case of adamantinoma located to pelvic bone in Iran. Here we present the clinical, radiological ＆ histopathological features of a 19 year-old male with painful lesion located to the right pelvic bone which was morphologically and immunohistochemically diagnosed as adamantinoma. In general, metastasis is seen in 15%-20% of patients. The spread can occur to regional nodes, lung and infrequently to skeleton, liver and brain . Several weeks after surgery, our patient＇s condition gradually worsened. A CT-scan of abdomen revealed widespread liver metastasis and the patient died due to acute liver failure. This case demonstrates that the mortality rate from adamantinoma is not always low.

X-ray DIAGNOSIS OF EXTRASKELETAL (SOFT TISSUE) CHONDROSARCOMA (A REPORT OF 8 CASES)

Eight cases of surgically and pathologically verified extraskeletal (soft tissue) chondrosarcoma were analyzed with regard to clinical and X-ray features. The cardinal clinical aspects of this series are: presence of a local soft tissue mass; gradual enlargement of the mass accompanied by increasing pain. The X-ray signs were summarized as follows: formation of a soft tissue mass; various forms of calcifications concentrated in the central area of the tumor; in some instances, presence of a saucer-like defect on the cortical surface of neighbouring bone and periosteal proliferation with mound-like new bone on both sides as well as bending deformity of the affected bone. The incidence and sites of predilection, the main X-ray findings, radiological diagnosis and differential diagnosis of the tumor were discussed. The Roentgen features of synovial chondrosarcoma of the knee joint were especially analyzed.

X-ray DIAGNOSIS OF JUXTACORTICAL CHONDROSARCOMA (A REPORT OF 16 CASES)

The clinical and radiologic features of 16 cases of surgically and pathologically proved juxtacortical chondrosarcoma were analyzed. The main radiograp-hic findings include: (1) A saucerlike or scalloped defect confined to the outer surface of cortex dut to tumor erosion; (2) Localized cortical proliferation and sclerosis; (3) Soft tissue mass and various forms of calcification within the tumor; but without a bony or calcified shell around the tumor mass and (4) sunray and/or laminated periosteal reaction. The origin of this tumor, its histopathology and classification were discussed. A preliminary investigation on the radiated periosteal reaction and its pathological basis was performed.

Magnetic Resonance Imaging for Diagnosis and Analysis of Bone Tumors and Bone Tuberculosis

The purpose of the study is to explore the diagnostic value of magnetic resonance imaging in bone tuberculosis and bone tumors.Firstly,148 patients with bone tumor and bone tuberculosis were selected,74 cases in each group.Perform magnetic resonance imaging(MRI)examinations on all patients,relevant parameters were set and the changes in the value of the dispersion system were recorded to obtain T1-weighted imaging and T2-weighted imaging.The results showed that among 74 patients,41 cases were bone damage,38 cases were joint swelling,27 cases were sparse bone,10 cases were bone hyperplasia and 5 cases were dead bone and calcification.The imaging manifestations of bone tumors were 45 cases of fractures,26 cases of surrounding soft tissue infiltration,10 cases of hip duct enlargement and 11 cases of sacral foramen enlargement.After MRI diagnosis,the accuracy of diagnosing 74 cases of bone tumor was 100%,and the accuracy of diagnosing 65 cases of bone tuberculosis was 87.84%.The difference between the two groups was statistically significant(P<0.05).The diffusion sensitivity coefficient of MRI weighted imaging was 150 s/mm2,and there was no significant difference in ADC values between the two groups(P>0.05).When the diffusion sensitivity coefficient is 300 s/mm2,and the difference between the two groups was statistically significant(P<0.05).Therefore,MRI had a certain diagnostic value for bone tuberculosis and bone tumors,and MRI had a higher diagnostic value and richer information for bone tumors.Corresponding treatment can be performed to improve the prognosis.

Role of Plain Abdominal X-Ray in the Differential Diagnosis of Common Acute Abdominal Conditions in Children at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria

Background: The plain abdominal x-ray is one of the commonly requested investigations in the children emergency room, paediatric surgical ward and neonatal wards. The short interval required to carry out this investigative procedure and obtain results makes it the first imaging modality used to unravel the different causes of acute abdominal conditions in children. The safety of abdominal x-ray in children makes it attractive for use in paediatric surgical practice as part of routine work-up for undifferentiated acute abdominal conditions and also to diagnose specific causes of acute abdomen in children. Setting: Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State. Objectives: Evaluation of the role of plain abdominal x-ray in diagnosing common acute abdominal conditions in children. Materials and method: Patients admitted to the children emergency room, paediatric surgical wards, children’s ward and neonatal ward who had plain abdominal x-ray as part of their diagnostic work-up were included in the study. They were studied prospectively between March 2011 and April 2021. Results: Three Hundred and Ninety-nine patients who had plain abdominal x-rays as part of their diagnostic work-up were studied. Males were 240 while females were 159, a male to female ratio of 1.5:1. The patients were aged between 1 day to 16 years. Differential diagnoses made with plain abdominal x-ray were intestinal obstruction in 298, perforated viscus 69 patients, intra-abdominal masses 13 patients and location of intra-abdominal foreign body 14. Intestinal obstruction cases in which plain abdominal x-ray played a role in their diagnosis and management included the following: intussusception 66, neonatal sepsis 60, malrotation 48, intestinal atresia 42, anorectal malformation 32, hirschsprung’s disease in 30 cases, pyloric stenosis 24, obstructed hernia 22, post-operative adhesions 16 and intestinal helminthiasis 12. Perforated viscus accounted for 69 indications. Out of these indications, perforated gut in intussusception 19, perforated typhoid ileitis was responsible in 13 cases, gut perforation in blunt abdominal trauma 8, perforation in strangulated hernia 11 cases, perforated gut in malrotation 7, ceacal perforation in hirschsprugs disease 6 and colonic perforation in necrotizing enterocolitis 5 cases. Conclusion: Plain abdominal x-ray remains a role to play in the differential diagnosis and management of common paediatric acute abdominal conditions.

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.

Research Progress on Diagnosis and Treatment of Chronic Osteomyelitis

We review the representatives literatures on chronic osteomyelitis,sum up the new insights in recent years into diagnostic options and treatment regimens,analyze the advantages and disadvantages of various diagnostic approaches and treatment strategies,and propose areas of interest to make current diagnostic and treatment strategies more specific.

Computer-Aided Diagnosis for Tuberculosis Classification with Water Strider Optimization Algorithm

Computer-aided diagnosis(CAD)models exploit artificial intelligence(AI)for chest X-ray(CXR)examination to identify the presence of tuberculosis(TB)and can improve the feasibility and performance of CXR for TB screening and triage.At the same time,CXR interpretation is a time-consuming and subjective process.Furthermore,high resemblance among the radiological patterns of TB and other lung diseases can result in misdiagnosis.Therefore,computer-aided diagnosis(CAD)models using machine learning(ML)and deep learning(DL)can be designed for screening TB accurately.With this motivation,this article develops a Water Strider Optimization with Deep Transfer Learning Enabled Tuberculosis Classification(WSODTL-TBC)model on Chest X-rays(CXR).The presented WSODTL-TBC model aims to detect and classify TB on CXR images.Primarily,the WSODTL-TBC model undergoes image filtering techniques to discard the noise content and U-Net-based image segmentation.Besides,a pre-trained residual network with a two-dimensional convolutional neural network(2D-CNN)model is applied to extract feature vectors.In addition,the WSO algorithm with long short-term memory(LSTM)model was employed for identifying and classifying TB,where the WSO algorithm is applied as a hyperparameter optimizer of the LSTM methodology,showing the novelty of the work.The performance validation of the presented WSODTL-TBC model is carried out on the benchmark dataset,and the outcomes were investigated in many aspects.The experimental development pointed out the betterment of the WSODTL-TBC model over existing algorithms.

Preliminary determination of calcium,phosphorus,and the calcium/phosphorus ratio in cortical bone of Chinstrap penguin using synchrotron X-ray fluorescence analysis

Synchrotron radiation X-ray fluorescence （SR-XRF） approach was applied to analyzing of Chinstrap penguin （ Pygoscelis Antarctica） cortical bone. The method enabled the in situ determination of Ca and P concentrations and the Ca/P ratio in cortical bone. The preliminary results show that ： （ 1 ） there is the bone site-related difference for Ca and P concentrations. The mean values for the investigated parameters （ on a dry-weight basis） are： 30.7% （Ca） and 14.9% （P） for the femoral cortical bone, 21.4% （Ca） and 11.5% （P） for wing cortical bone. （2） The variation for the Ca/P ratio in cortical bone is lower than those for Ca and P separately. This is in agreement with the previous report that the specificity of the Ca/P ratio is better than that of Ca and P concentrations and is more reliable for the diagnosis of bone disorders. The authors suggest that further studies be conducted to establish norreal values of Ca, P and Ca/P ratio for polar animals and provide a basis for the diagnosis of bone disorders.

BONE MINERAL ANALYSIS OF WHOLE BODY IN 292 NORMAL SUBJECTS ASSESSED BY DUAL X-RAY ABSORPTIOMETRY

Objective. To study the whole body bone mineral changes in normal subjects.Methods. Bone mineral was measured by dual X-ray absorptiometry(DXA) in 292 normal subjectsaged 10～79 years, including 152 females and 140 males. They were divided into age-groups by decade.Results. In males, the ages with peak value of total bone mineral content (TBMC), total bone min-eral density (TBMD), anteroposterior spine BMD(L2-4 BMD) were in the 30～39,20～39, 20～29 age-groups respectively. In females, they were all in the 30～39 age-group. Peak values of TBMC, TBMD,L2-4 BMD were higher in males than those in females. Loss of bone mineral for females was more pro-nounced than that for males. Loss of L2-4 BMD was more pronounced than TBMD.Conclusion. This study provides the normal bone mineral data of whole body for males and females,and the characteristic of changes.