Standard diagnostic report of medical imaging

1 BackgroundIt is well known that the radiology diagnostic report as the essential component of the patient′s permanent health record,which radiography is an indispensable diagnostic tool.Our duties are observe the imaging carefully and write a

Incremental value of magnetic resonance neurography of Lumbosacral plexus over non-contributory lumbar spine magnetic resonance imaging in radiculopathy: A prospective study

AIM: To test the incremental value of 3T magnetic resonance neurography(MRN) in a series of unilateral radiculopathy patients with non-contributory magnetic resonance imaging(MRI).METHODS: Ten subjects(3 men,7 women; mean age54 year and range 22-74 year) with unilateral lumbar radiculopathy and with previous non-contributory lumbar spine MRI underwent lumbosacral(LS) plexus MRN over a period of one year. Lumbar spine MRI performed as part of the MRN LS protocol as well as bilateral L4-S1 nerves,sciatic,femoral and lateral femoral cutaneous nerves were evaluated in each subject for neuropathy findings on both anatomic(nerve signal,course and caliber alterations) and diffusion tensor imaging(DTI)tensor maps(nerve signal and caliber alterations).Minimum fractional anisotropy(FA) and mean apparent diffusion coeffcient(ADC) of L4-S2 nerve roots,sciatic and femoral nerves were recorded.RESULTS: All anatomic studies and 80% of DTI imaging received a good-excellent imaging quality grading. In a blinded evaluation,all 10 examinations demonstrated neural and/or neuromuscular abnormality corresponding to the site of radiculopathy. A number of contributory neuropathy findings including double crush syndrome were observed. On DTI tensor maps,nerve signal and caliber alterations were more conspicuous. Although individual differences were observed among neuropathic appearing nerve(lower FA and increased ADC) as compared to its contralateral counterpart,there were no significant mean differences on statistical comparison of LS plexus nerves,femoral and sciatic nerves(P > 0.05).CONCLUSION: MRN of LS plexus is useful modality for the evaluation of patients with non-contributory MRI of lumbar spine as it can incrementally delineate the etiology and provide direct objective and non-invasive evidence of neuromuscular pathology.

Dermoid Ovarian Cyst Complicated with Torsion in a Girl of 11 Years Old at the Teaching Hospital Sanou Souro of Bobo-Dioulasso (Burkina Faso): About an Observation and Review of the Literature

The dermoid ovarian is an organic mild tumor. It can be revealed by an adnexal torsion which constitutes a gynecological emergency that can bring into play in a short term after the functional prognosis. We are reporting an observed case in an 11-year-old teenager who is in times peri-pubertal. The patient was presenting a painful abdomino-pelvic syndrome and a pelvic mass at the physical examination. The ultrasound was showing a right cyst mass with a right moderated hydronephrosis. A right adnexectomy was realized. The histological test after excision of the adnexal was showing a mature cystic teratoma of the right ovary with a congestive and edematous tubal fragment.

Quintuplet Pregnancy: A Rare Case after Clomiphene Citrate Therapy and Review of Literature

Multiple pregnancies are increasing with the progress in Assisted Reproductive Technology. The authors report a case of quintuplet pregnancy after Clomiphene Citrate stimulation. This is a 28-year-old woman, G2, P1 with a 4-year-old child alive, who consulted for maternity desire. She was treated with Clomiphene Citrate at 100 mg daily for five days. The presence of a quintuplet pregnancy at 8 weeks + 5 days was found by ultrasound on 29/12/2018. During the follow up of the pregnancy, she presented pre-eclampsia from 24th week (TA 140/100 mmHg, significant proteinuria, edema of lower limbs). Methyl Dopa treatment was instituted. Tocolytic treatment with Salbumol was prescribed facing uterine contractions at 30 weeks. The patient had premature rupture of membranes at 34 weeks + 4 days, followed by uterine contractions. She had a cesarean section at the same day with the birth of five newborns alive. This is the first reported case in Burkina Faso.

Giant androgen-producing adrenocortical carcinoma with atrial flutter: A case report and review of the literature

BACKGROUND Adrenocortical carcinoma(ACC),the second most aggressive malignant tumor,lacks epidemiological data worldwide;therefore,every new case can improve the understanding of the pathology and treatment of this malignancy.CASE SUMMARY We present the case of a 66-year-old Caucasian woman with a giant androgenproducing ACC(21 cm×17 cm×12 cm;2100 g),without metastases,which unusually presented with an acute onset of atrial flutter and congestive heart failure.The cardiac complications observed in our case support the hypothesis that androgen excess in women is a cardiovascular risk factor.Androgen excess in women can be a rare cause of reversible dilated cardiomyopathy,therefore a comprehensive approach to the patient is essential to improve the recognition of androgen-secreting ACC.The atrial flutter was remitted after initiation of drug treatment during admission.The severe heart failure was totally remitted at 6 mo after radical open surgery to remove the giant ACC.CONCLUSION Radical open surgery to remove a giant androgen-producing ACC was the firstline treatment to cure the excess of androgen,which determined the total remission of cardiac complications at 6 mo after surgery in the women of this case report.

Adaptive deep learning for head and neck cancer detection using hyperspectral imaging

It can be challenging to detect tumor margins during surgery for complete resection.The purpose of this work is to develop a novel learning method that learns the difference between the tumor and benign tissue adaptively for cancer detection on hyperspectral images in an animal model.Specifically,an auto-encoder network is trained based on the wavelength bands on hyperspectral images to extract the deep information to create a pixel-wise prediction of cancerous and benign pixel.According to the output hypothesis of each pixel,the misclassified pixels would be reclassified in the right prediction direction based on their adaptive weights.The auto-encoder network is again trained based on these updated pixels.The learner can adaptively improve the ability to identify the cancer and benign tissue by focusing on the misclassified pixels,and thus can improve the detection performance.The adaptive deep learning method highlighting the tumor region proved to be accurate in detecting the tumor boundary on hyperspectral images and achieved a sensitivity of 92.32%and a specificity of 91.31%in our animal experiments.This adaptive learning method on hyperspectral imaging has the potential to provide a noninvasive tool for tumor detection,especially,for the tumor whose margin is indistinct and irregular.

I-123 metaiodobenzylguanidine imaging for predicting ventricular arrhythmia in heart failure patients

Compared to antiarrhythmic drugs,implantable cardioverter defibrillator(ICD)leads to a more significant improvement in preventing ventricular arrhythmia in heart failure patients.However,an important question has been raised that how to select appropriate patients for ICD therapy.I-123 metaiodobenzylguanidine(MIBG)planar and SPECT imaging have shown great potentials to predict ventricular arrhythmia in heart failure patients by assessing the abnormalities of the sympathetic nervous system.Clinical trials demonstrated that several parameters measured from I-123 MIBG planar and SPECT imaging,such as heart-to-mediastinum ratio,washout rate,defect score,and innervation/perfusion mismatch,predicted ventricular arrhythmias in heart failure patients.This paper introduces the current practice of ICD therapy and reviews the technical background of I-123 MIBG planar and SPECT imaging and their clinical data in predicting ventricular arrhythmia.

3T magnetic resonance neurography of pudendal nerve with cadaveric dissection correlation

AIM: To evaluate the pudendal nerve segments that could be identified on magnetic resonance neurography(MRN) before and after surgical marking of different nerve segments.METHODS: The hypothesis for this study was that pudendal nerve and its branches would be more easily seen after the surgical nerve marking. Institutional board approval was obtained. One male and one female cadaver pelvis were obtained from the anatomy board and were scanned using 3 Tesla MRI scanner using MR neurography sequences. All possible pudendal nerve branches were identified. The cadavers were then sent to the autopsy lab and were surgically dissected by a peripheral nerve surgeon and an anatomist to identify the pudendal nerve branches. Radiological markers were placed along the course of the pudendal nerve and its branches. The cadavers were then closed and rescanned using the same MRN protocol as the premarking scan. The remaining pudendal nerve branches were attempted to be identified using the radiological markers. All scans were read by an experienced musculoskeletal radiologist.RESULTS: The pre-marking MR Neurography scans clearly showed the pudendal nerve at its exit from the lumbosacral plexus in the sciatic notch, at the level of the ischial spine and in the Alcock's Canal in both cadavers. Additionally, the right hemorrhoidal branch could be identified in the male pelvis cadaver. The perineal and distal genital branches could not be identified. On post-marking scans, the markers were used as identifiable structures. The location of the perineal branch, the hemorroidal branch and the dorsal nerve to penis(in male cadaver)/clitoris(in female cadaver) could be seen. However, the visualization of these branches was suboptimal. The contralateral corresponding nerves were poorly seen despite marking on the surgical side. The nerve was best seen on axial T1W and T2W SPAIR images. The proximal segment could be seen well on 3D DW PSIF sequence. T2W SPACE was not very useful in visualization of this small nerve or its branches.CONCLUSION: Proximal pudendal nerve is easily seen on MR neurography, however it is not possible to identify distal branches of the pudendal nerve even after surgical marking.

Magnetic resonance imaging-guided focused ultrasound to increase localized blood-spinal cord barrier permeability

Spinal cord injury(SCI) affects thousands of people every year in the USA, and most patients are left with some permanent paralysis. Therapeutic options are limited and only modestly affect outcome. To address this issue, we used magnetic resonance imaging-guided focused ultrasound(MRg FUS) as a non-invasive approach to increase permeability in the blood-spinal cord barrier(BSCB). We hypothesize that localized, controlled sonoporation of the BSCB by MRg FUS will aid delivery of therapeutics to the injury. Here, we report our preliminary findings for the ability of MRg FUS to increase BSCB permeability in the thoracic spinal cord of a normal rat model. First, an excised portion of normal rat spinal column was used to characterize the acoustic field and to estimate the insertion losses that could be expected in an MRg FUS blood spinal cord barrier opening. Then, in normal rats, MRg FUS was applied in combination with intravenously administered microbubbles to the spinal cord region. Permeability of the BSCB was indicated as signal enhancement by contrast administered prior to T1-weighted magnetic resonance imaging and verified by Evans blue dye. Neurological testing using the Basso, Beattie, and Breshnahan scale and the ladder walk was normal in 8 of 10 rats tested. Two rats showed minor impairment indicating need for further refinement of parameters. No gross tissue damage was evident by histology. In this study, we have opened successfully the blood spinal cord barrier in the thoracic region of the normal rat spine using magnetic resonance-guided focused ultrasound combined with microbubbles.

Same day yttrium-90 radioembolization with single photon emission computed tomography/computed tomography: An opportunity to improve care during the COVID-19 pandemic and beyond

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has made it more challenging for patients to undergo yttrium-90(Y-90)radioembolization(RE).Same day Y-90 RE provides an opportunity to minimize logistical challenges and infection risk associated with COVID-19,thus improving patient access.AIM To describe the use of same day Y-90 RE with routine single photon emission computed tomography/computed tomography(SPECT/CT)in order to optimize therapy.METHODS All patients were selected for Y-90 RE through a multidisciplinary tumor board,and were screened and tested for COVID-19 infection per institutional protocol.A same day procedure was developed,consisting of angiography,imaging,and Y-90 resin particle delivery.Routine SPECT/CT after technetium-99m macroaggregated albumin(Tc-99m MAA)administration was performed for assessment of arterial supply,personalized dosimetry,and extrahepatic activity.Post-treatment Y-90 bremsstrahlung SPECT/CT was performed for confirmation of particle delivery,by utilization of energy windowing to limit signal from previously administered Tc-99m MAA particles.RESULTS A total of 14 patients underwent same day Y-90 RE between March and June 2020.Mean lung shunt fraction was 6.13%(range 3.5%-13.1%).Y-90 RE was performed for a single lesion in 7 patients,while the remaining 7 patients had treatment of multifocal lesions.The largest lesion measured 8.3 cm.All patients tolerated the procedure well and were discharged the same day.CONCLUSION Same day Y-90 RE with resin-based microspheres is feasible,and provides an opportunity to mitigate infection risk and logistical challenges associated with the COVID-19 pandemic and beyond.We recommend consideration of SPECT/CT,especially among patients with complex malignancies,for the potential to improve outcomes and eligibility of patients to undergo same day Y-90 RE.

A projection-domain iterative algorithm for metal artifact reduction by minimizing the total-variation norm and the negative-pixel energy

Metal objects in X-ray computed tomography can cause severe artifacts.The state-of-the-art metal artifact reduction methods are in the sinogram inpainting category and are iterative methods.This paper proposes a projectiondomain algorithm to reduce the metal artifacts.In this algorithm,the unknowns are the metal-affected projections,while the objective function is set up in the image domain.The data fidelity term is not utilized in the objective function.The objective function of the proposed algorithm consists of two terms:the total variation of the metalremoved image and the energy of the negative-valued pixels in the image.After the metal-affected projections are modified,the final image is reconstructed via the filtered backprojection algorithm.The feasibility of the proposed algorithm has been verified by real experimental data.

Influence of postural changes on haemodynamics in internal carotid artery bifurcation aneurysm using numerical methods

Cerebral intracranial aneurysms are serious problems that can lead to stroke,coma,and even death.The effect of blood flow on cerebral aneurysms and their relationship with rupture are unknown.In addition,postural changes and their relevance to haemodynamics of blood flow are difficult to measure in vivo using clinical imaging alone.Computational simulations investigating the detailed haemodynamics in cerebral aneurysms have been developed in recent times not only to understand the progression and rupture but also for clinical evaluation and treatment.In the present study,the haemodynamics of a patient-specific case of a large aneurysm on the left side internal carotid bifurcation(LICA)and no aneurysm on the right side internal carotid bifurcation(RICA)was investigated.The simulation of these patient-specific models using fluid–structure interaction provides a valuable comparison of flow behavior between normal and aneurysm models.The influences of postural changes were investigated during standing,sleeping,and head-down(HD)position.Significant changes in flow were observed during the HD position and quit high arterial blood pressure in the internal carotid artery(ICA)aneurysm model was established when compared to the normal ICA model.The velocity increased abruptly during the HD position by more than four times(LICA and RICA)and wall shear stress by four times(LICA)to ten times(RICA).The complex spiral flow and higher pressures prevailing within the dome increase the risk of aneurysm rupture.

Apolipoprotein E knockout rabbit model of intracranial atherosclerotic disease

Intracranial atherosclerotic disease(ICAD) is the most common cause of ischemic stroke. Poor understanding of the disease due to limited human data leads to imprecise treatment. Apolipoprotein E knockout(ApoE-KO) rabbits were compared to an existing model, the Watanabe heritable hyperlipidemic(WHHL) rabbit, and wild-type New Zealand white(NZW) rabbit controls. Intracranial artery samples were assessed on histopathology for the presence of ICAD. Logistic and ordinal regression analyses were performed to assess for disease presence and severity, respectively. Eighteen rabbits and 54 artery segments were analyzed. Univariate logistic analysis confirmed the presence of ICAD in model rabbits(P <.001), while no difference was found between WHHL and ApoE-KO rabbits(P =.178). In multivariate analysis, only classification as a model vs wild-type animal(P <.001) was associated with the presence of ICAD. Univariate ordinal regression analysis demonstrated an association between ICAD severity and model animals(P =.001), with no difference was noted between WHHL and ApoE-KO rabbits(P =.528). In multivariate ordinal regression analysis, only classification as a model retained significance(P <.001). ICAD can be reliably produced in ApoE-KO rabbits, developing the disease comparably to the older WHHL model. Further analysis is warranted to optimize accelerated development of ICAD in ApoE-KO rabbits to more efficiently study this disease.

Diagnostic Evaluation of GeneXpert MTB/RIF Assay for the Detection of Rifampicin Resistant Mycobacterium tuberculosis among Pulmonary Tuberculosis Patients in Bangladesh

Background: The emergence of multidrug resistant tuberculosis (MDR-TB) and extensively drug- resistant tuberculosis (XDR-TB) has highlighted the need for early accurate detection and drug susceptibility. Objective: The purpose of the present study was to evaluate the accuracy of GeneX-pert MTB/RIF assay for the detection of Mycobacterium tuberculosis and rifampicin resistance. Methodology: This cross sectional study was done in the Department of Microbiology at Sir Salimullah Medical College, Dhaka and National Institute of Chest Disease & Hospital (NIDCH), Dhaka during the period of January 2014 to December 2014 for a period of 1 (one) year. Sputum samples from suspected MDR-TB patients were collected by purposive sampling technique from OPD of Sir Salimullah Medical College (SSMC) and NIDCH. Microscopy, liquid culture in liquid MGIT 960 media and GeneXpert MTB/RIF were done for MTB diagnosis and detection of rifampicin resistance. MGIT 960 media were also used for determination of drug resistance. Result: Liquid culture yielded higher growth (68%) from 100 samples while GeneXpert MTB assay showed similar result (67% positive and 33% negative). Drug susceptibility test in MGIT 960 media showed that out of 68 positive cases Rifampicin resistant cases were 15 (22.05%) whereas GeneXpert MTB assay detected 14 (20.89%) were Rifampicin resistant out of 67 MTB positive samples. When compared to liquid culture the calculated sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy of GeneXpert MTB were 98.52%, 100%, 96.96%, 100% and 99%. Conclusion: GeneXpert MTB/RIF assay is high detection rate of pulmonary tuberculosis and multidrug resistant tuberculosis.

The frontiers of nuclear cardiology research

Heart disease is the leading cause of death.Each year in the United States,more than 500,000 men and women die from coronary artery disease(CAD).CAD results from the narrowing of blood vessels that supply the heart.The blood vessels become narrow when fatty deposits build up inside the arterial wall.When the arteries become clogged,the blood flow to the myocardium is impaired and a heart attack can occur.Nuclear cardiology studies use noninvasive imaging techniques to assess myocardial blood flow.

Detecting white matter alterations in multiple sclerosis using advanced diffusion magnetic resonance imaging

Multiple sclerosis is a neurodegenerative and inflammatory disease, a hallmark of which is demyelinating lesions in the white matter. We hypothesized that alterations in white matter microstructures can be non-invasively characterized by advanced diffusion magnetic resonance imaging. Seven diffusion metrics were extracted from hybrid diffusion imaging acquisitions via classic diffusion tensor imaging, neurite orientation dispersion and density imaging, and q-space imaging. We investigated the sensitivity of the diffusion metrics in 36 sets of regions of interest in the brain white matter of six female patients(age 52.8 ± 4.3 years) with multiple sclerosis. Each region of interest set included a conventional T2-defined lesion, a matched perilesion area, and normal-appearing white matter. Six patients with multiple sclerosis(n = 5) or clinically isolated syndrome(n = 1) at a mild to moderate disability level were recruited. The patients exhibited microstructural alterations from normal-appearing white matter transitioning to perilesion areas and lesions, consistent with decreased tissue restriction, decreased axonal density, and increased classic diffusion tensor imaging diffusivity. The findings suggest that diffusion compartment modeling and q-spa ce analysis appeared to be sensitive for detecting subtle microstructural alterations between perilesion areas and normal-appearing white matter.

Iterative analytic extension in tomographic imaging

If a spatial-domain function has a finite support,its Fourier transform is an entire function.The Taylor series expansion of an entire function converges at every finite point in the complex plane.The analytic continuation theory suggests that a finite-sized object can be uniquely determined by its frequency components in a very small neighborhood.Trying to obtain such an exact Taylor expansion is difficult.This paper proposes an iterative algorithm to extend the measured frequency components to unmeasured regions.Computer simulations show that the proposed algorithm converges very slowly,indicating that the problem is too ill-posed to be practically solvable using available methods.

Poisson-noise weighted filter for time-offlight positron emission tomography

Image reconstruction for list-mode time-of-flight(TOF)positron emission tomography(PET)can be achieved by analytic algorithms.The backprojection filtering(BPF)algorithm is an efficient algorithm for this task.The conventional noise control method for analytic image reconstruction is the use of a stationary lowpass filter,which does not model the Poisson noise properly.This study proposes a nonstationary filter for Poisson noise control.The filter is implemented in the spatial domain in a form similar to convolution.

Non-iterative image reconstruction from sparse magnetic resonance imaging radial data without priors

The state-of-the-art approaches for image reconstruction using under-sampled k-space data are compressed sensing based.They are iterative algorithms that optimize objective functions with spatial and/or temporal constraints.This paper proposes a non-iterative algorithm to estimate the un-measured data and then to reconstruct the image with the efficient filtered backprojection algorithm.The feasibility of the proposed method is demonstrated with a patient magnetic resonance imaging study.The proposed method is also compared with the state-of-the-art iterative compressed-sensing image reconstruction method using the total-variation optimization norm.

Analytic time-of-flight positron emission tomography reconstruction: threedimensional case

In a positron emission tomography(PET)scanner,the time-of-flight(TOF)information gives us rough event position along the line-of-response(LOR).Using the TOF information for PET image reconstruction is able to reduce image noise.The state-of-the-art TOF PET image reconstruction uses iterative algorithms.This study introduces an analytic TOF PET algorithm that focuses on three-dimensional(3D)reconstruction.The proposed algorithm is in the form of backprojection filtering,in which the backprojection is performed first by using a time-resolution profile function,and then a 3D filter is applied to the backprojected image.For the list-mode data,the backprojection is carried out in the event-by-event fashion,and the timing resolution determined weighting function is used along the projection LOR.Computer simulations are carried out to verify the feasibility of the proposed algorithm.