Multimodal imaging diagnosis and analysis of prognostic factors in patients with adult-onset Coats disease

AIM:To describe the multimodal imaging features,treatment,and outcomes of patients diagnosed with adultonset Coats disease.METHODS:This retrospective study included patients first diagnosed with Coats disease at≥18 years of age between September 2017 and September 2021.Some patients received anti-vascular endothelial growth factor(VEGF)therapy(conbercept,0.5 mg)as the initial treatment,which was combined with laser photocoagulation as needed.All the patients underwent best corrected visual acuity(BCVA)and intraocular pressure examinations,fundus color photography,spontaneous fluorescence tests,fundus fluorescein angiography,optical coherence tomography(OCT),OCT angiography,and other examinations.BCVA alterations and multimodal image findings in the affected eyes following treatment were compared and the prognostic factors were analyzed.RESULTS:The study included 15 patients who were aged 24-72(57.33±12.61)y at presentation.Systemic hypertension was the most common associated systemic condition,occurring in 13(86.7%)patients.Baseline BCVA ranged from 2.0 to 5.0(4.0±1.1),which showed improvement following treatment(4.2±1.0).Multimodal imaging revealed retinal telangiectasis in 13 patients(86.7%),patchy hemorrhage in 5 patients(33.3%),and stage 2B disease(Shield’s staging criteria)in 11 patients(73.3%).OCT revealed that the baseline central macular thickness(CMT)ranged from 129 to 964μm(473.0±230.1μm),with 13 patients(86.7%)exhibiting a baseline CMT exceeding 250μm.Furthermore,8 patients(53.3%)presented with an epiretinal membrane at baseline or during follow-up.Hyper-reflective scars were observed on OCT in five patients(33.3%)with poor visual prognosis.Vision deteriorated in one patient who did not receive treatment.Final vision was stable in three patients who received laser treatment,whereas improvement was observed in one of two patients who received anti-VEGF therapy alone.In addition,8 of 9 patients(88.9%)who received laser treatment and conbercept exhibited stable or improved BCVA.CONCLUSION:Multimodal imaging can help diagnose adult-onset Coats disease.Anti-VEGF treatment combined with laser therapy can be an option for improving or maintaining BCVA and resolving macular edema.The final visual outcome depends on macular involvement and the disease stage.

Multimodal imaging in the diagnosis of bone giant cell tumors:A retrospective study

BACKGROUND Giant cell tumor of bone is a locally aggressive and rarely metastasizing tumor,and also a potential malignant tumor that may develop into a primary malignant giant cell tumor.AIM To evaluate the role of multimodal imaging in the diagnosis of giant cell tumors of bone.METHODS The data of 32 patients with giant cell tumor of bone confirmed by core-needle biopsy or surgical pathology at our hospital between March 2018 and March 2023 were retrospectively selected.All the patients with giant cell tumors of the bone were examined by X-ray,computed tomography(CT)and magnetic resonance imaging(MRI),and 7 of them were examined by positron emission tomography(PET)-CT.RESULTS X-ray imaging can provide overall information on giant cell tumor lesions.CT and MRI can reveal the characteristics of the internal structure of the tumor as well as the adjacent relationships of the tumor,and these methods have unique advantages for diagnosing tumors and determining the scope of surgery.PET-CT can detect small lesions and is highly valuable for identifying benign and malignant tumors to aid in the early diagnosis of metastasis.CONCLUSION Multimodal imaging plays an important role in the diagnosis of giant cell tumor of bone and can provide a reference for the treatment of giant cell tumors.

Multimodal imaging for the diagnosis of oligodendroglioma associated with arteriovenous malformation:A case report

BACKGROUND The rare co-occurrence of oligodendroglioma and arteriovenous malformation(AVM)in the same intracranial location.CASE SUMMARY In a 61-year-old man presenting with progressive headaches,is described in this case study.Preoperative multimodal imaging techniques(computed tomography,magnetic resonance imaging,magnetic resonance spectroscopy,digital subtraction angiography,and computed tomography angiography)were employed to detect hemorrhage,cystic and solid lesions,and arteriovenous shunting in the right temporal lobe.The patient underwent right temporal craniotomy for lesion removal,and postoperative pathological analysis confirmed the presence of oligodendroglioma(World Health Organization grade II,not otherwise specified)and AVM.CONCLUSION The preoperative utilization of multimodal imaging examination can help clinicians reduce the likelihood of misdiagnosis or oversight of these conditions,and provides important information for subsequent treatment.This case supports the feasibility of craniotomy for the removal of glioma with AVM.

Nomogram based on multimodal magnetic resonance combined with B7-H3mRNA for preoperative lymph node prediction in esophagus cancer

Accurate preoperative prediction of lymph node metastasis(LNM)in esophageal cancer(EC)patients is of crucial clinical significance for treatment planning and prognosis.AIM To develop a clinical radiomics nomogram that can predict the preoperative lymph node(LN)status in EC patients.METHODS A total of 32 EC patients confirmed by clinical pathology(who underwent surgical treatment)were included.Real-time fluorescent quantitative reverse transcription-polymerase chain reaction was used to detect the expression of B7-H3 mRNA in EC tissue obtained during preoperative gastroscopy,and its correlation with LNM was analyzed.Radiomics features were extracted from multi-modal magnetic resonance imaging of EC using Pyradiomics in Python.Feature extraction,data dimensionality reduction,and feature selection were performed using XGBoost model and leave-one-out cross-validation.Multivariable logistic regression analysis was used to establish the prediction model,which included radiomics features,LN status from computed tomography(CT)reports,and B7-H3 mRNA expression,represented by a radiomics nomogram.Receiver operating characteristic area under the curve(AUC)and decision curve analysis(DCA)were used to evaluate the predictive performance and clinical application value of the model.RESULTS The relative expression of B7-H3 mRNA in EC patients with LNM was higher than in those without metastasis,and the difference was statistically significant(P<0.05).The AUC value in the receiver operating characteristic(ROC)curve was 0.718(95%CI:0.528-0.907),with a sensitivity of 0.733 and specificity of 0.706,indicating good diagnostic performance.The individualized clinical prediction nomogram included radiomics features,LN status from CT reports,and B7-H3 mRNA expression.The ROC curve demonstrated good diagnostic value,with an AUC value of 0.765(95%CI:0.598-0.931),sensitivity of 0.800,and specificity of 0.706.DCA indicated the practical value of the radiomics nomogram in clinical practice.CONCLUSION This study developed a radiomics nomogram that includes radiomics features,LN status from CT reports,and B7-H3 mRNA expression,enabling convenient preoperative individualized prediction of LNM in EC patients.

Application of multimodal image fusion technology in brain tumor surgical procedure

Objective: To construct brain tumors and their surrounding anatomical structures through the method of registration, fusion and, three-dimensional(3D) reconstruction based on multimodal image data and to provide the visual information of tumor, skull,brain, and vessels for preoperative evaluation, surgical planning, and function protection.Methods: The image data of computed tomography(CT) and magnetic resonance imaging(MRI) were collected from fifteen patients with confirmed brain tumors.We reconstructed brain tumors and their surrounding anatomical structures using Neuro Tech software. Results: The whole 3D structures including tumor, brain surface, skull, and vessels were successfully reconstructed based on the CT and MRI images. Reconstruction image clearly shows the tumor size, location, shape, and the anatomical relationship of tumor and surrounding structures. We can hide any reconstructed images such as skull,brain tissue, blood vessles, or tumors. We also can adjust the color of reconstructed images and rotate images to observe the structures from any direction. Reconstruction of brain and skull can be semi transparent to display the deep structure; reconstruction of the structures can be axial, coronal, and sagittal cutting to show relationship among tumor and surrounding structures. The reconstructed 3D structures clearly depicted the tumor features, such as size, location, and shape, and provided visual information of the spatial relationship among its surrounding structures. Conclusions: The method of registration, fusion, and 3D reconstruction based on multimodal images to provide the visual information is feasible and practical. The reconstructed 3D structures are useful for preoperative assessment, incision design,the choice of surgical approach, tumor resection, and functional protection.

Clinical and multimodal imaging features of acute macular neuroretinopathy lesions following recent SARS-CoV-2 infection

AIM:To describe the clinical characteristics of eyes using multimodal imaging features with acute macular neuroretinopathy(AMN)lesions following severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection.METHODS:Retrospective case series study.From December 18,2022 to February 14,2023,previously healthy cases within 1-week infection with SARS-CoV-2 and examined at Tianjin Eye Hospital to confirm the diagnosis of AMN were included in the study.Totally 5 males and 9 females[mean age:29.93±10.32(16-49)y]were presented for reduced vision,with or without blurred vision.All patients underwent best corrected visual acuity(BCVA),intraocular pressure,slit lamp microscopy,indirect fundoscopy.Simultaneously,multimodal imagings fundus photography(45°or 200°field of view)was performed in 7 cases(14 eyes).Near infrared(NIR)fundus photography was performed in 9 cases(18 eyes),optical coherence tomography(OCT)in 5 cases(10 eyes),optical coherence tomography angiography(OCTA)in 9 cases(18 eyes),and fundus fluorescence angiography(FFA)in 3 cases(6 eyes).Visual field was performed in 1 case(2 eyes).RESULTS:Multimodal imaging findings data from 14 patients with AMN were reviewed.All eyes demonstrated different extent hyperreflective lesions at the level of the inner nuclear layer and/or outer plexus layer on OCT or OCTA.Fundus photography(45°or 200°field of view)showed irregular hypo-reflective lesion around the fovea in 7 cases(14 eyes).OCTA demonstrated that the superficial retinal capillary plexus(SCP)vascular density,deep capillary plexus(DCP)vascular density and choriocapillaris(CC)vascular density was reduced in 9 case(18 eyes).Among the follow-up cases(2 cases),vascular density increased in 1 case with elevated BCVA;another case has vascular density decrease in one eye and basically unchanged in other eye.En face images of the ellipsoidal zone and interdigitation zone injury showed a low wedge-shaped reflection contour appearance.NIR image mainly show the absence of the outer retinal interdigitation zone in AMN.No abnormal fluorescence was observed in FFA.Corresponding partial defect of the visual field were visualized via perimeter in one case.CONCLUSION:The morbidity of SARS-CoV-2 infection with AMN is increased.Ophthalmologists should be aware of the possible,albeit rare,AMN after SARS-CoV-2 infection and focus on multimodal imaging features.OCT,OCTA,and infrared fundus phase are proved to be valuable tools for detection of AMN in patients with SARS-CoV-2.

A novel image fusion algorithm based on 2D scale-mixing complex wavelet transform and Bayesian MAP estimation for multimodal medical images

In this paper,we propose a new image fusion algorithm based on two-dimensional Scale-Mixing Complex Wavelet Transform(2D-SMCWT).The fusion of the detail 2D-SMCWT cofficients is performed via a Bayesian Maximum a Posteriori(MAP)approach by considering a trivariate statistical model for the local neighboring of 2D-SMCWT coefficients.For the approx imation coefficients,a new fusion rule based on the Principal Component Analysis(PCA)is applied.We conduct several experiments using three different groups of multimodal medical images to evaluate the performance of the proposed method.The obt ained results prove the superiority of the proposed method over the state of the art fusion methods in terms of visual quality and several commonly used metrics.Robustness of the proposed method is further tested against different types of noise.The plots of fusion met rics establish the accuracy of the proposed fusion method.

Multimodal MRI diagnosis and transvenous embolization of a basicranial emissary vein dural arteriovenous fistula:A case report

A dural arteriovenous fistula(DAVF) is an abnormal linkage connecting the arterial and venous systems within the intracranial dura mater. A basicranial emissary vein DAVF drains into the cavernous sinus and the ophthalmic vein, similar to a cavernous sinus DAVF. Precise preoperative identification of the DAVF location is a prerequisite for appropriate treatment. Treatment options include microsurgical disconnection, endovascular transarterial embolization(TAE), transvenous embolization(TVE), or a combination thereof. TVE is an increasingly popular approach for the treatment of DAVFs and the preferred approach for skull base locations, due to the risk of cranial neuropathy caused by dangerous anastomosis from arterial approaches. Multimodal magnetic resonance imaging(MRI) can provide anatomical and hemodynamic information for TVE. The therapeutic target must be precisely embolized in the emissary vein, which requires guidance via multimodal MRI. Here, we report a rare case of successful TVE for a basicranial emissary vein DAVF, utilizing multimodal MRI assistance. The fistula had vanished, pterygoid plexus drainage had improved, and the inferior petrosal sinus had recanalized, as observed on 8-month follow-up angiography. Symptoms and signs of double vision, caused by abduction deficiency, disappeared. Detailed anatomic and hemodynamic assessment by multimodal MRI is the key to guiding successful diagnosis and treatment.

Tuberous sclerosis complex combined with primary lymphedema:A case report

BACKGROUND Tuberous sclerosis complex(TSC)and primary lymphedema(PLE)are both rare diseases,and it is even rarer for both to occur in the same patient.In this work,we have provided a detailed description of a patient's clinical presentation,imaging findings,and treatment.And a retrospective analysis was conducted on 14 published relevant case reports.CASE SUMMARY A 16-year-old male came to our hospital for treatment due to right lower limb swelling.This swelling is already present from birth.The patient’s memory had been progressively declining.Seizures had occurred 1 year prior at an unknown frequency.The patient was diagnosed with TSC combined with PLE through multimodal imaging examination:Computed tomography,magnetic resonance imaging,and lymphoscintigraphy.The patient underwent liposuction.The swelling of the patient's right lower limb significantly improved after surgery.Epilepsy did not occur.after taking antiepileptic drugs and sirolimus.CONCLUSION TSC with PLE is a rare and systemic disease.Imaging can detect lesions of this disease,which are important for diagnosis and treatment.

Multimodality imaging in nanomedicine and nanotheranostics

Accurate diagnosis of tumors needs much detailed information. However, available single imaging modality cannot provide complete or comprehensive data. Nanomedicine is the application of nanotechnology to medicine, and multimodality imaging based on nanoparticles has been receiving extensive attention. This new hybrid imaging technology could provide complementary information from different imaging modalities using only a single injection of contrast agent. In this review, we introduce recent developments in multifunctional nanoparticles and their biomedical applications to multimodal imaging and theragnosis as nanomedicine. Most of the reviewed studies are based on the intrinsic properties of nanoparticles and their application in clinical imaging technology. The imaging techniques include positron emission tomography, single-photon emission computed tomography, computerized tomography, magnetic resonance imaging, optical imaging, and ultrasound imaging.

Multimodal imaging in acute retinal ischemia: spectral domain OCT, OCT-angiography and fundus autofluorescence

AIM： To describe retinal findings of various imaging modalities in acute retinal ischemia. METHODS： Fluorescein angiography（FA）, spectral domain optical coherence tomography（SD-OCT）, OCTangiography（OCT-A） and fundus autofluorescence（FAF） images of 13 patients（mean age 64y, range 28-86y） with acute retinal ischemia were evaluated. Six suffered from branch arterial occlusion, 2 had a central retinal artery occlusion, 2 had a combined arteriovenous occlusions, 1 patient had a retrobulbar arterial compression by an orbital haemangioma and 2 patients showed an ocular ischemic syndrome.RESULTS： All patients showed increased reflectivity and thickening of the ischemic retinal tissue. In 10 out of 13 patients SD-OCT revealed an additional highly reflective band located within or above the outer plexiform layer. Morphological characteristics were a decreasing intensity with distance from the fovea, partially segmental occurrence and manifestation limited in time. OCT-A showed a loss of flow signal in the superficial and deep capillary plexus at the affected areas. Reduced flow signal was detected underneath the regions with retinal edema. FAF showed areas of altered signal intensity at the posterior pole. The regions of decreased FAF signal corresponded to peri-venous regions. CONCLUSION： Multimodal imaging modalities in retinal ischemia yield characteristic findings and valuable diagnostic information. Conventional OCT identifies hyperreflectivity and thickening and a mid-retinal hyperreflective band is frequently observed. OCT-A examination reveals demarcation of the ischemic retinal area on the vascular level. FAF shows decreased fluorescence signal in areas of retinal edema often corresponding to peri-venous regions.

Advanced multimodality imaging of inflammatory bowel disease in 2015: An update

The diagnosis and effective management of inflammatory bowel disease(IBD) requires a combination clinical, endoscopic, histological, biological, and imaging data. While endoscopy and biopsy remains the gold standard for diagnosis of IBD, imaging plays a central role in the assessment of extra mural disease, in disease surveillance and in the assessment of response to medical treatments, which are often expensive. Imaging is also vital in the detection and diagnosis of disease related complications, both acute and chronic. In this review, we will describe, with illustrative images, the imaging features of IBD in adults, with emphasis on upto-date imaging techniques focusing predominantly on cross sectional imaging and new magnetic resonance imaging techniques.

Video-rate multimodal multiphoton imaging and three-dimensional characterization of cellular dynamics in wounded skin

To date,numerous studies have been performed to elucidate the complex cellular dynamics in skin diseases,but few have attempted to characterize these cellular events under conditions similar to the native environment.To address this challenge,a three-dimensional(3D)multimodal analysis platform was developed for characterizing in vivo cellular dynamics in skin,which was then utilized to process in vivo wound healing data to demonstrate its applicability.Special attention is focused on in vivo biological parameters that are difficult to study with ex vivo analysis,including 3D cell tracking and techniques to connect biological information obtained from different imaging modalities.These results here open new possibilities for evaluating 3D cellular dynamics in vivo,and can potentially provide new tools for characterizing the skin microenvironment and pathologies in the future.

Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis:A contemporary narrative review

Infective endocarditis is one of the leading life-threatening infections around the world.With the exponential growth in the field of transcatheter interventions and advances in specialized surgical techniques,the number of prosthetic valves and cardiac implantable devices has significantly increased.This has led to a steep rise in the number of cases of prosthetic valve endocarditis(PVE)comprising up to 30%of all cases.Clinical guidelines rely on the use of the modified Duke criteria;however,the diagnostic sensitivity of the modified Duke criteria is reduced in the context of PVE.This is in part attributed to prosthesis related artifact which greatly affects the ability of echocardiography to detect early infective changes related to PVE in certain cases.There has been increasing recognition of the roles of complementary imaging modalities and updates in international society recommendations.Prompt diagnosis and treatment can prevent the devastating consequences of this condition.Imaging modalities such as cardiac computed tomography and 18-fluorodeoxyglucose positron emission tomography/computed tomography are diagnostic tools that provide a complementary role to echocardiography in aiding diagnosis,pre-operative planning,and treatment decisionmaking process in these challenging cases.Understanding the strengths and limitations of these adjuvant imaging modalities is crucial for the implementation of appropriate imaging modalities in clinical practice.

Multimodal Imaging with 3D-Holograms for Preoperative Planning in Pediatric Cardiac Surgery:A Unique Case Report

Multimodal imaging,including augmented or mixed reality,transforms the physicians’interaction with clinical imaging,allowing more accurate data interpretation,better spatial resolution,and depth perception of the patient’s anatomy.We successfully overlay 3D holographic visualization to magnetic resonance imaging images for preoperative decision making of a complex case of cardiac tumour in a 7-year-old girl.

Multifunctional conjugated polymer nanoparticles for photoacoustic-based multimodal imaging and cancer photothermal therapy

Photoacoustic imaging(PAI)is a hybrid imaging method based on photoacoustic(PA)effects,which is able to capture the structure,function,and molecular information of biological tissues with high resolution.To date,therapeutic techniques under the guidance of PAI have provided new strategies for accurate diagnosis and precise treatment of tumors.In particular,conjugated polymer nanoparticles have been extensively inspected for PA-based cancer theranostics largely due to their superior optical properties such as tunable spectrum and large absorption coefficient and their good biocompatibility,and abundant functional groups.This mini-review mainly focuses on the recent advances toward the development of novel conjugated polymer nanoparticles for PA-based multimodal imaging and cancer photothermal therapy.

A huge thrombosed aneurysm of a saphenous vein graft leading to compression of cardiac structures： role of multimodality imaging

Aneurysmal change of saphenous vein grafts （SVG） is a rare condition that predominantly develops 10-20 years after coronary artery bypass graft （CABG）. Natural course includes mechanical complications due to mass effect, myocardial infarction and aneurysmal rupture. Aneurysmectomy can be considered when it induces such complications. We demonstrate complete set of diagnosis, treatment and post-operative imaging of a huge SVG aneurysm that was successfully treated with surgical resection.

Design and validation of a navigation system of multimodal medical images for neurosurgery based on mixed reality

Purpose: This paper aims to develop a navigation system based on mixed reality, which can displaymultimodal medical images in an immersive environment and help surgeons locate the target areaand surrounding important tissues precisely.Methods: To be displayed properly in mixed reality, medical images are processed in this system.High-quality cerebral vessels and nerve fibers with proper colors are reconstructed and exported tomixed reality environment. Multimodal images and models are registered and fused, extracting theirkey information. The multiple processed images are fused with the real patient in the same coordinatesystem to guide the surgery.Results: The multimodal image system is designed and validated properly. In phantom experiments,the average error of preoperative registration is 1.003 mm and the standard deviation is 0.096 mm.The average proportion of well-registered areas is 94.9%. In patient experiments, the surgeons whoparticipated in the experiments generally indicated that the system had excellent performance andgreat application prospect for neurosurgery.Conclusion: This article proposes a navigation system of multimodal images for neurosurgery basedon mixed reality. Compared with other navigation methods, this system can help surgeons locate thetarget area and surrounding important tissues more precisely and rapidly.

Review of intelligent diagnosis methods for imaging gland cancer based on machine learning

Gland cancer is a high-incidence disease that endangers human health,and its early detection and treatment require efficient,accurate,and objective intelligent diagnosis methods.In recent years,the advent of machine learning techniques has yielded satisfactory results in intelligent gland cancer diagnosis based on clinical images,significantly improving the accuracy and efficiency of medical image interpretation while reducing the workload of doctors.The focus of this study is to review,classify,and analyze intelligent diagnosis methods for imaging gland cancer based on machine learning and deep learning.This paper briefly introduces some basic imaging principles of multimodal medical images,such as the commonly used computed tomography(CT),magnetic resonance imaging(MRI),ultrasound(US),positron emission tomography(PET),and pathology.In addition,the intelligent diagnosis methods for imaging gland cancer were further classified into supervised learning and weakly supervised learning.Supervised learning consists of traditional machine learning methods,such as K-nearest neighbor algorithm(KNN),support vector machine(SVM),and multilayer perceptron,and deep learning methods evolving from convolutional neural network(CNN).By contrast,weakly supervised learning can be further categorized into active learning,semisupervised learning,and transfer learning.State-of-the-art methods are illustrated with implementation details,including image segmentation,feature extraction,and optimization of classifiers.Their performances are evaluated through indicators,such as accuracy,precision,and sensitivity.In conclusion,the challenges and development trends of intelligent diagnosis methods for imaging gland cancer were addressed and discussed.

Bicuspid aortic valve with associated aortopathy, significant left ventricular hypertrophy or concomitant hypertrophic cardiomyopathy: A diagnostic and therapeutic challenge

Due to its prevalence of 0.5%to 2%in the general population,with a 75%predominance among men,bicuspid aortic valve is the most common congenital heart defect.It is frequently accompanied by other cardiac congenital anomalies,and clinical presentation can vary significantly,with stenosis being the most common manifestation,often resulting in mild to moderate concentric hypertrophy of the left ventricle.Echocardiography is the primary diagnostic modality utilized for establishing the diagnosis,and it is often the sole diagnostic tool relied upon by clinicians.However,due to the heterogeneous clinical presentation and possible associated anomalies(which are often overlooked in clinical practice),it is necessary to employ various diagnostic methods and persist in finding the accurate diagnosis if multiple inconsistencies exist.By employing this approach,we can effectively manage these patients and provide them with appropriate treatment.Through a clinical case from our practice,we provide an overview of the literature on bicuspid aortic valve with aortophaty and the possible association with hypertrophic cardiomyopathy,diagnostic methods,and treatment options.This review article highlights the critical significance of achieving an accurate diagnosis in patients with bicuspid aortic valve and significant left ventricular hypertrophy.It is crucial to exclude other possible causes of left ventricular outflow tract obstruction,such as sub-or supra-aortic obstructions,and hypertrophic cardiomyopathy.