Abnormal Lesions Research Articles

176Associated factor for abnormal cervical citology in women with HIV at a hospital in Peru

Abstract Background Women living with HIV (WLWH) are at higher risk of abnormal cervical lesions. The aim of this study was to determine the risk factors associated with abnormal cytology in WLWH Methods A case-control study was performed, all WLWH >18 years were enrolled at Cayetano Heredia Hospital during 2012-2015. A case and control were defined as a WLWH with abnormal pap smear and with normal pap smear, respectively. Factors associated with the increased risk of abnormal pap smear in WLWH were assessed using logistic regression modeling Results We assessed 141 cases and 227 controls. Alcohol consumption was diagnosed in 30.5% (43/141) of the case group and 18.1% (41/227) of the control group. In the case group, 75.2% (106/141) were on antiretroviral treatment (ART) while 85.1% (193/227) in the control group were in ART. Additionally, 37% of cases (40/106) and the 23.1 % of controls (40/173) had virologic failure. The multivariate model showed that alcohol consumption (OR 1.77, IC95% 1.06-2.95), be in virologic failure (OR 2.41, IC95% 1.55-3.74) and were on ART (OR 0.07, IC95% 0.02-0.23) were associated with abnormal cytology Conclusions Alcohol consumption and virologic failure are significant risk factors associated with abnormal cytology. ART was found to be a protective factor. Screening for these factors in WLWH, should be considered for promoting the prevention with pap smear. Key message We have to have consider periodic screening with pap smear for cervical cancer in this population as mandatory

Cervical Intraepithelial Lesions in Women with Persistent Inflammatory Smear on Pap Smear: A Descriptive Cross-sectional Study.

Persistent inflammatory smear is a benign finding on pap test but is associated with premalignant lesion of the cervix. Further evaluation is therefore necessary. This study was done to determine the prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear. This is descriptive observational study conducted in Department of Obstetrics and Gynaecology of tertiary care centre of Nepal from 15th May 2020 to 14th May 2021 after obtaining ethical clearance from Institutional Review Board (Reference no MEMG/IRC/338/GA). Women with two consecutive pap smear reports showing inflammatory findings were enrolled. Colposcopy was performed and Modified Reid's colposcopic index was used to grade the lesions. Colposcopic guided biopsy was taken and tissue sent for histopathology for abnormal colposcopic lesions. Data analysis was done using Statistical Package for Social Sciences version 21 and frequency and percentages were used to present data. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Among 115 women, 57 (49.5%) at 95% Confidence Interval (40.37-58.63) had Cervical Intraepithelial lesions. Among them 48 (41.7%) had low grade intraepithelial lesions and 9 (7.8%) had high grade lesions on colposcopy. The prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear on pap was higher in our study compared to other studies.

Optimal number of strong labels for curriculum learning with convolutional neural network to classify pulmonary abnormalities in chest radiographs.

It is important to alleviate annotation efforts and costs by efficiently training on medical images. We performed a stress test on several strong labels for curriculum learning with a convolutional neural network to differentiate normal and five types of pulmonary abnormalities in chest radiograph images. The numbers of CXR images of healthy subjects and patients, acquired at Asan Medical Center (AMC), were 6069 and 3465, respectively. The numbers of CXR images of patients with nodules, consolidation, interstitial opacity, pleural effusion, and pneumothorax were 944, 550, 280, 1360, and 331, respectively. The AMC dataset was split into training, tuning, and test, with a ratio of 7:1:2. All lesions were strongly labeled by thoracic expert radiologists, with confirmation of the corresponding CT. For curriculum learning, normal and abnormal patches (N=26658) were randomly extracted around the normal lung and strongly labeled abnormal lesions, respectively. In addition, 1%, 5%, 20%, 50%, and 100% of strong labels were used to determine an optimal number for them. Each patch dataset was trained with the ResNet-50 architecture, and all CXRs with weak labels were used for fine-tuning them in a transfer-learning manner. A dataset acquired from the Seoul National University Bundang Hospital (SNUBH) was used for external validation. The detection accuracies of the 1%, 5%, 20%, 50%, and 100% datasets were 90.51, 92.15, 93.90, 94.54, and 95.39, respectively, in the AMC dataset and 90.01, 90.14, 90.97, 91.92, and 93.00 in the SNUBH dataset. Our results showed that curriculum learning with over 20% sampling rate for strong labels are sufficient to train a model with relatively high performance, which can be easily and efficiently developed in an actual clinical setting.

Analytical performance of aPROMISE: automated anatomic contextualization, detection, and quantification of [18F]DCFPyL (PSMA) imaging for standardized reporting

PurposeThe application of automated image analyses could improve and facilitate standardization and consistency of quantification in [18F]DCFPyL (PSMA) PET/CT scans. In the current study, we analytically validated aPROMISE, a software as a medical device that segments organs in low-dose CT images with deep learning, and subsequently detects and quantifies potential pathological lesions in PSMA PET/CT.MethodsTo evaluate the deep learning algorithm, the automated segmentations of the low-dose CT component of PSMA PET/CT scans from 20 patients were compared to manual segmentations. Dice scores were used to quantify the similarities between the automated and manual segmentations. Next, the automated quantification of tracer uptake in the reference organs and detection and pre-segmentation of potential lesions were evaluated in 339 patients with prostate cancer, who were all enrolled in the phase II/III OSPREY study. Three nuclear medicine physicians performed the retrospective independent reads of OSPREY images with aPROMISE. Quantitative consistency was assessed by the pairwise Pearson correlations and standard deviation between the readers and aPROMISE. The sensitivity of detection and pre-segmentation of potential lesions was evaluated by determining the percent of manually selected abnormal lesions that were automatically detected by aPROMISE.ResultsThe Dice scores for bone segmentations ranged from 0.88 to 0.95. The Dice scores of the PSMA PET/CT reference organs, thoracic aorta and liver, were 0.89 and 0.97, respectively. Dice scores of other visceral organs, including prostate, were observed to be above 0.79. The Pearson correlation for blood pool reference was higher between any manual reader and aPROMISE, than between any pair of manual readers. The standard deviations of reference organ uptake across all patients as determined by aPROMISE (SD = 0.21 blood pool and SD = 1.16 liver) were lower compared to those of the manual readers. Finally, the sensitivity of aPROMISE detection and pre-segmentation was 91.5% for regional lymph nodes, 90.6% for all lymph nodes, and 86.7% for bone in metastatic patients.ConclusionIn this analytical study, we demonstrated the segmentation accuracy of the deep learning algorithm, the consistency in quantitative assessment across multiple readers, and the high sensitivity in detecting potential lesions. The study provides a foundational framework for clinical evaluation of aPROMISE in standardized reporting of PSMA PET/CT.

In vivo optical coherence tomography in assessment of suspicious facial lesions: A prospective study

BackgroundSkin cancer continues to be the most common cancer in the Caucasian population. Over the past two decades, researchers around the world started assessing the possibility of diagnosing tissue pathologies by using optical systems. In this study, we aimed to use in vivo optical coherence tomography (OCT) technology to describe the morphologic features of normal and pathologic skin conditions. Materials and methodsIn this study, 72 patients with suspected skin pre-cancer/cancer were recruited. The lesions were subjected to in vivo OCT scanning using compact size probe. The main scanned areas were the centre of the lesion, periphery of the lesion and control reading at least 2cm from the lesion periphery but within the same dermatomal distribution. Following assessment, each lesion was surgically excised. All acquired OCT images were correlated with the corresponding histopathology images to ensure an accurate diagnosis and appropriate co-localisation of abnormal lesion on both OCT image and pathology slide. This was achieved in every resected lesion. ResultsHistopathological analysis revealed that of the 96 macroscopically suspicious scanned lesions 26 were actinic keratosis (AK), 51 were basal cell carcinoma (BCC) and 19 were cutaneous squamous cell carcinoma (SCC). Different layers of healthy skin can be distinguished with clear demarcation between the epidermis and papillary dermis. An increase in epidermal thickness was observed in OCT images in AK that appeared relatively hyperintense. Cutaneous SCC was characterized by hypoechoic signal free spaces within the dermis and damaged of dermal-epidermal junction. BCCs were visualized as hypoechoic structures but showed a mixed echogenicity. Solid nodular BCC appeared as single or multiple areas with no clear arrangement surrounding low-reflectivity lobular structures surrounded. Cystic structures were identifiable by signal-free areas adjacent to healthy skin. Sensitivity and specificity for in vivo OCT in diagnosing these lesions were impressive, based on this small sample size. ConclusionsOCT have shown that there are qualitative differences in OCT image features of skin with varying degrees of pathology, and between normal and pathological skin. This study indicates that in vivo OCT shows a good promise as a useful optical diagnostic technique in diagnosing skin pathologies.

Effectiveness of cryotherapy in VIA positive women

Introduction: In this study we studied the effectiveness of Cryotherapy in cases with abnormal squamous intraepithelial lesions detected only by VIA.
 Method: In our study, 64 patients in reproductive age group attending gynecology OPD, with complaints of discharge per vaginum, lower abdominal pain, and post coital bleeding were screened with VIA and positive women had cryotherapy and they were followed up by same after six months.
 Result: A total of 64 VIA positive women had cryotherapy. Most of the women were of age group 31-40 years (40.6%). Majority of the women were of parity 2 or more (89.1%). The most common complaint was discharge (46.9%) followed by pelvic pain (32.8%). VIA was negative among most of the women (87.5%) after cryotherapy. The outcome of cryotherapy was not associated with age and parity rather presence of symptoms was statistically associated (p=0.034).
 Conclusion: We concluded that in low resource settings, simple and safe diagnostic test VIA and therapeutic procedure cryotherapy are safe and effective method to combat the killer disease of cervical cancer.
 Keywords: Cryotherapy, Visual inspection with acetic acid (VIA), cervix

Diagnostic Accuracy of Hysterosonography in Diagnosis of Uterine Lesions by Taking Hysteroscopy as Gold Standard

Background and Aim: Evaluation of uterine abnormalities is infertility core partto be assessed in impaired reproduction cases. Uterine abnormalities can be assessed by various radiological imaging modalities such as transvaginal sonography, hysterosalpingography and hysterosonography. The current study aims to evaluate the diagnostic accuracy of hysterosonography in diagnosis of uterine lesions by taking hysteroscopy as gold standard. Materials and Methods: This observation-based cross-sectional study was carried out on 108 reproductive-age women at the Department of Obstetrics and Gynecology of Liaquat University of Medical and Health Sciences, Jamshoro during the period from January 2020 to June 2020.These women had uterine abnormalities such as recurrent pregnancy loss, abnormal uterine bleeding, infertility, and clinically diagnosed lesions of intrauterine. All individuals underwent hysteroscopy evaluation.Global sensitivity analysis technique was used to calculate the bias-adjusted specificity and sensitivity of hysterosonography. Uterine abnormalities were assessed by hysteroscopy taking it as a gold standard. SPSS version 20 was used for data analysis. Results:The mean age of the women was 27.3 ± 5.63 with age range 20 to 34 years and parity ranged from 0 to 5. Out of 108 patients, 49 (45.4%) had positive findings of abnormal uterine lesions including myomas in 13 (12.3%), polyps 17 (15.7%), uterine septum 7 (6.4%) and intrauterine adhesions 12 (11.1%). Among all, forty-nine (45.4%) women had infertility, previous cesarean section 20 (19.1%), recurrent pregnancy loss 18 (16.6%), and menstrual disorders 21 (19.4%).Diagnostic accuracy of hysterosonography in terms of specificity, sensitivity, and Positive prediction value (PPV) was 94%, 77%, and 74% for uterine lesions respectively while taking hysteroscopy as a gold standard. Conclusion: The present study concluded that uterine lesions among reproductive-age women could be easily assessed with higher accuracy of hysterosonography. Based on the specificity and sensitivity of hysteroscopy as a gold standard for hysterosonography is the most reliable, safe and accurate diagnostic technique for uterine lesions. Keywords:Hysterosonography, Uterine lesions

Cervical glandular neoplasia referrals and the diagnosis of adenocarcinoma in situ: Correlating cytology, colposcopy findings, and clinical outcomes.

To determine the clinical outcomes of women with possible glandular neoplasia of endocervical type on cervical cytology, and review all diagnoses of cervical adenocarcinoma in situ (AIS) over a 5year period at our institution. A retrospective case-note review was conducted of all women referred to colposcopy with possible glandular neoplasia of endocervical type on cervical cytology or diagnosed with cervical AIS after biopsy or excision, from January 2014 until December 2018 in a London district hospital. Of 55 women referred with possible glandular neoplasia of endocervical type, 47 (85.4%) had a significant pathology on histopathological analysis: AIS (n=22); invasive cancer (n=7); high-grade cervical intraepithelial neoplasia (n=18). Women with a history of borderline abnormality on cervical cytology within the last 5years were significantly more likely to be diagnosed with AIS or invasive cancer (P<.05). For the same period 49 women had histologically proven AIS. Among these 22 (44.8%) were referred as possible cervical glandular intraepithelial neoplasia. Other reasons for referral were the following indications: borderline dyskaryosis (n=13); high-grade dyskaryosis (n=8); low-grade dyskaryosis (n=4); postcoital bleeding (n=2). Due to the raised risk of significant gynaecological pathology in women with possible glandular neoplasia of endocervical type on cervical cytology, excisional biopsy is essential. Colposcopic impression varies significantly and complete excision of the abnormal lesions should be achieved. AIS is a histological diagnosis and should always be considered during colposcopical and cytopathological assessment.

Role of MRI in Differentiating Various Posterior Cranial Fossa Space-Occupying Lesions Using Sensitivity and Specificity: A Prospective Study

Background: Any abnormal space-occupying posterior fossa lesion may directly involve the vital structures like the brain stem, cranial nerves, cerebellum, vertebrobasilar artery, and venous sinuses, which makes the surgical approach and total excision very difficult. Hence for these reasons, precise evaluation of posterior fossa lesion with MRI is a must to visualize the vital structures, which helps in planning and safe surgery. Objective: This study aimed to evaluate the added value of diffusion-weighted imaging and magnetic resonance spectroscopy in the localization, extension, characterization, differentiation of various posterior fossa space-occupying lesions, and correlating with the histopathological result.Materials and methods: This prospective study comprised of 40 patients who were suspected with posterior fossa space-occupying lesions on basis of clinical features or on CT scan. All patients were evaluated using conventional as well as newer MRI techniques using Siemens 1.5 Tesla MRI scanner (Siemens Medical System, Erlangen, Germany). Diffusion-weighted imaging (DWI) was done in all patients and magnetic resonance spectroscopy (MRS) was done in 27 patients. Based on the MRI findings, various posterior fossa lesions were classified as neoplastic or non-neoplastic. The neoplastic lesions were further classified as benign and malignant. The MRI findings were correlated with histopathological findings or follow-up.Statistical analysis: Independent sample t-test was used to compare the mean apparent diffusion coefficient (ADC) values of various posterior fossa space-occupying lesions. Receiver operating characteristic (ROC) curve analysis was done to determine the optimal cut-off mean ADC values and choline/creatinine (Cho/cr) ratios for various benign and malignant posterior fossa tumors.Results: Of 40 patients with posterior fossa lesions, 23 were males and 17 were females with a mean age of 34.67±1.93[SD] years. Metastases were the most common posterior fossa lesions in our study sample and found in seven patients (17.5%) followed by vestibular schwannomas and brainstem gliomas in five patients (12.5%) each, demyelinating lesion in four patients (10%), tubercular abscess in three patients (7.5%), hemangioblastoma, tuberculoma, arachnoid cyst, epidermoid cyst, pilocytic astrocytoma, low-grade glioma in two patients (5%) each, meningioma, medulloblastoma, pyogenic abscess and high-grade glioma in one patient (2.5%) each. The mean ADC value of benign tumors was higher than that of malignant tumors and this difference was found to be significant (p = 0.019). The cut-off ADC value 1.022 x 10-3mm2/s had a sensitivity of 78.6% and specificity of 66.7%. MRS played important role in differentiating neoplastic from non-neoplastic lesions and benign from malignant tumors. The cut-off Cho/cr ratio of 1.25 had a sensitivity of 66.7%, specificity of 85.7% to differentiate benign from malignant tumors.Conclusion: Conventional MRI sequences able to diagnose most of the benign-appearing lesions of posterior fossa, however, adding advanced MRI sequences like diffusion-weighted imaging and MR spectroscopy helps us to differentiate and diagnose various posterior fossa lesions even closer to the actual histopathological diagnosis.

Solitary vaginal paraganglioma with mature sacrococcygeal teratoma: a rare case report

BackgroundVaginal paraganglioma are rare, atypical, solitary tumors which originate from the female genital tract. Sacrococcygeal teratoma are also rare neoplasms which derive from one (or more) primordial germ cell layers. Here we report a unique case of vaginal paraganglioma with sacrococcygeal teratoma.Case presentationA 44-year-old female experienced paroxysmal hypertension, palpitations and dizziness for almost six years. Enhanced CT and MRI highlighted two abnormal soft tissue lesions located in the left vaginal wall and coccyx anteriorly, and Iodine-131 metaiodobenzylguanidine (131I-MIBG) demonstrated abnormal radioactive uptake in perineum area. Endocrine tests showed elevated plasma normetanephrine (NMN) and 24 h urine norepinephrine. There was a well-circumscribed soft tissue lesion of approximately 3.5 cm in the left lateral vaginal wall which could be palpated during bimanual examination, together with a 1.5 cm tumor in the posterior wall of the rectum. We completely resected the two lesions in stages with the support of a senior gynecologist and general surgeons. Postoperative histopathological examinations suggested the vaginal paraganglioma and mature sacrococcygeal teratoma. Targeted sanger sequencing for the 36 mostly common paraganglioma-related genes, with a depth of 1000x, revealed no mutations. Post-operatively, plasma NMN and 24 h urine norepinephrine returned to the normal range and her symptoms completely disappeared.ConclusionsWe reported an extremely rare case and the successful treatment of functional vaginal paraganglioma coexisting with adult sacrococcygeal teratoma.

MRI features of ERSA (exercise-related signal abnormality) lesions in professional soccer players

ObjectiveThis study aims to describe the prevalence, anatomy and morphology of ERSA (exercise-related signal abnormality) lesions, a previously undescribed pattern of muscle signal changes on MRI in professional soccer players with suspected acute thigh muscle injury.MethodsA multicenter retrospective review was performed of 287 MRIs of professional soccer players referred for suspected acute thigh injury from August 2017 to February 2020. MR images were reviewed for muscle signal abnormalities corresponding to a peritendinous ovoid region or a subfascial ring of faint increased signal on fluid-sensitive MR images. Imaging features including anatomical site, morphology, and craniocaudal length were recorded. Concomitant acute muscle injury was graded in accordance with the British Athletics Muscle Injury Classification (BAMIC).ResultsERSA lesions comprising a peritendinous ovoid region, a subfascial ring, or both, were identified in 40 muscles across 31/287 studies (10.8%). These lesions had a mean length of 15.8 cm and were predominantly located in the proximal or mid-portions of muscles. Affected muscles were rectus femoris (n = 22), adductor longus (n = 11), semitendinosus (n = 6) and biceps femoris (n = 1). 21/31 studies (67.7%) had a BAMIC grade 1–4 injury in a separate muscle, which were largely (81%) in a separate anatomic compartment or contralateral.ConclusionERSA lesions were evident on MRI in 10.8% of our cohort of professional soccer players referred for suspected acute thigh muscle injury. Characteristic morphology and the longitudinal length (mean 15.8 cm) distinguish ERSA lesions from recognized patterns of acute muscle injury.

Changing Spectrum of Cardiac Diseases in Children: An Extended Longitudinal Observation Study of a Pediatric Cardiac Screening Program.

The spectrum of cardiac diseases in children is distinct from that in adults, and changes with advances in medical care and socioeconomic conditions. Such data are important for the allocation of medical resources, but are unclear. Based on a longitudinal pediatric cardiac screening program, we sought to delineate the spectrum and the trends. From 2002 to 2018, citywide screening programs of cardiac diseases for children were performed in Taipei, Taiwan. Participants, mainly students entering the first grade of elementary school, were evaluated using questionnaires, simplified 4-lead electrocardiography (EKG), phonocardiography, and physical examinations. Those suspected of having abnormal cardiac lesions received detailed evaluations by pediatric cardiologists for a final diagnosis. The median prevalence of cardiac lesions in the children was 19.60/1000 (range from 14.9 to 24.65/1000), including congenital heart disease (32.02%), EKG abnormalities (33.34%), mitral valve prolapse (15.17%), Kawasaki disease (6.89%), rheumatic heart disease (0.17%) and others (12.41%). A significant time trend was only observed in a trend of decline in rheumatic heart disease. The median prevalence rates of congenital heart disease, Kawasaki disease, rheumatic heart disease, mitral valve prolapse, and EKG abnormalities were 6.20, 1.37, 0, 3.12, and 6.46 per 1000 children, respectively. This study, based on a citywide cardiac screening program, indicates that the spectrum of cardiac diseases in children has not changed in recent decades, except for a decline or disappearance of rheumatic heart disease in the Taipei metropolitan area. While congenital heart disease and EKG abnormalities were the most common, Kawasaki disease was the most commonly acquired heart disease in children.

Colletotrichum aenigma Associated with Apple Bitter Rot on Newly Bred cv. RubyS Apple

The abnormal brown sunken lesions were observed on cv. RubyS apple fruits in an orchard located in Gunwi, Gyeongbuk province, Korea. The primary observed symptoms such as small round sunken lesions and small black dots on the symptomatic area were different from the reported apple diseases. The affected apple fruits were sampled and subjected to isolation of the causal agent. Cultural and morphological characteristics of isolated fungal strain, designated KNUF-20GWA4, were similar to that of Colletotrichum spp. Based on multilocus sequence analyses using internal transcribed spacer regions and partial sequences of β-tubulin, glyceraldehyde-3-phosphate dehydrogenase, chitin synthase, and actin genes, strain KNUF-20GWA4 showed 99.2-100% similarities with C. aenigma ICMP 18608 and the isolate clustered together with several other strains of this species in the phylogenetic tree. To our knowledge, this is the first report of bitter rot on apple fruits caused by C. aenigma.

Prognostic Significance of Medullary Abnormalities of the Appendicular Skeleton Detected By Low-Dose Whole-Body Multidetector Computed Tomography in Patients with Multiple Myeloma

BackgroundWhole-body low-dose multidetector computed tomography (MDCT) is used to assess bone lesions of multiple myeloma (MM), because it can provide more information on lytic bone lesions than plain conventional X-ray examination. MDCT can also depict bone marrow involvement of the appendicular skeleton (AS) in patients with MM. However, there is little evidence whether MDCT-based imaging can predict prognosis in patients with MM. Previously, we reported the prognostic implications of medullary abnormalities of AS in patients with MM (Blood Cancer J 2015;5:e2329). Here, we updated our previous observations and confirmed the prognostic relevance of medullary abnormalities of AS detected by MDCT in patients with MM.Patients and MethodsThe initial study population consisted of 193 consecutive patients with newly diagnosed MM (NDMM) between January 2008 and June 2017 at Kameda Medical Center, Japan, undergoing MDCT in parallel with initial MM work-up. Six patients with cardiac amyloidosis were excluded because of its impact on survival. To differentiate marrow infiltration from physiological residual hematopoietic red marrow, a threshold of 30 HU was set. The normal pattern was defined as an absence of focal or diffuse high-density area in the medullary lesion with ≥ -30 HU recognized by MDCT. The diffuse pattern was defined as the presence of the abnormal CT value accounting for ≥ 70% of the bony canal. The focal pattern was defined as the presence of circumscribed high-density area which did not meet the definition of the normal or diffuse pattern (Figure A). Statistical analyses were performed with EZR, which is a graphical user interface for R ver. 3.2.2Ethical considerationsThis study was approved by the institutional review board of Kameda Medical Center and conducted in accordance with the principles of the Declaration of Helsinki.ResultsThe median age of the patients was 73 years and median observation period was 34.3 months. Among 187 patients, the numbers of patients with normal, focal, and diffuse pattern were 49 (26%), 101 (54%), and 37 (20%), respectively. All of the patients were treated with bortezomib or immunomodulatory drug (IMiD)-based combined chemotherapy in the frontline setting. There were no significant differences in age, sex, M-protein subtype, or clinical response between the three groups. There were significant differences in the proportion of patients with International Staging System (ISS) stage III (33%, 55%, 81%, respectively; P < 0.001) and Revised International Staging System (R-ISS) stage III (14%, 27%, 49%, respectively; P = 0.009) between the normal, focal, and diffuse medullary patterns of AS. The differences in progression free survival (PFS) between the three groups were not statistically significant (log-rank test P=0.18), but overall survival (OS) showed significant differences between groups (log-rank test P < 0.001; Figure B). The 5-year survival rates were 79%, 44%, and 33% for normal, focal, and diffuse patterns, respectively. Median OS values were 92 months, 56 months, and 41 months, respectively. The mortality risk was associated with age, ISS III, Druie & Salmon stage III, creatinine ≥ 2 mg/dL, and receipt of autologous stem cell transplantation (ASCT) on univariate analysis. On multivariate Cox regression analysis, the presence of abnormal medullary lesions detected by MDCT remained as the independent prognostic predictor for OS (normal vs. focal; hazard ratio 2.573; 95% confidence interval, 1.274 - 5.196; P= 0.008: normal vs. diffuse; hazard ratio 4.092; 95% confidence interval, 1.895 - 8.835; P < 0.001: Table).ConclusionOur results indicated that the presence of abnormal bone marrow lesions in the AS detected by MDCT is an independent prognostic factor in patients with NDMM, and patients with a diffuse pattern have shorter survival period than those with the focal pattern. Therefore, assessment of bone marrow involvement of AS detected by MDCT should be considered not only for diagnostic purposes for bony lytic lesions but also to predict the prognosis of NDMM in addition to other imaging modalities. [Display omitted] DisclosuresKitadate:Otsuka: Research Funding; Fujimoto: Research Funding; Novartis: Research Funding; Pfizer: Research Funding; Toyama kagaku: Research Funding; Chugai: Research Funding; Asahi Kasei: Research Funding; Kyowa Kirin: Research Funding; Eisai: Research Funding.

Limited recurrence distance of glioblastoma under modern radiotherapy era

BackgroundThe optimal treatment volume for Glioblastoma multiforme (GBM) is still a subject of debate worldwide. The current study was aimed to determine the distances between recurring tumors and the edge of primary lesions, and thereby provide evidence for accurate target area delineation.MethodsBetween October 2007 and March 2019, 68 recurrent patients with GBM were included in our study. We measured the distance from the initial tumor to the recurrent lesion of GBM patients by expanding the initial gross tumor volume (GTV) to overlap the center of recurrent lesion, with the help of the Pinnacle Treatment Planning System.ResultsRecurrences were local in 47(69.1%) patients, distant in 12(17.7%) patients, and both in 9(13.2%) patients. Factors significantly influencing local recurrence were age (P = 0.049), sex (P = 0.049), and the size of peritumoral edema (P = 0.00). A total number of 91 recurrent tumors were analyzed. All local recurrences occurred within 2 cm and 94.8% (55/58) occurred within 1 cm of the original GTV based on T1 enhanced imaging. All local recurrences occurred within 1.5 cm and 98.3%(57/58) occurred within 0.5 cm of the original GTV based on T2-FLAIR imaging. 90.9% (30/33) and 81.8% (27/33) distant recurrences occurred >3 cm of T1 enhanced and T2-Flair primary tumor margins, respectively.ConclusionsThe 1 cm margin from T1 enhanced lesions and 0.5 cm margin from T2-Flair abnormal lesions could cover 94.8 and 98.3% local recurrences respectively, which deserves further prospective study as a limited but effective target area.

Value of semiquantitative assessment of high-risk plaque features on coronary CT angiography over stenosis in selection of studies for FFRct

IntroductionThe degree of stenosis on coronary CT angiography (CCTA) guides referral for CT-derived flow reserve (FFRct). We sought to assess whether semiquantitative assessment of high-risk plaque (HRP) features on CCTA improves selection of studies for FFRct over stenosis assessment alone. MethodsPer-vessel FFRct was computed in 1,395 vessels of 836 patients undergoing CCTA with 25–99% maximal stenosis. By consensus analysis, stenosis severity was graded as 25–49%, 50–69%, 70–89%, and 90–99%. HRPs including low attenuation plaque (LAP), positive remodeling (PR), and spotty calcification (SC) were assessed in lesions with maximal stenosis. Lesion FFRct was measured distal to the lesion with maximal stenosis, and FFRct<0.80 was defined as abnormal. Association of HRP and abnormal lesion FFRct was evaluated by univariable and multivariable logistic regression models. ResultsThe frequency of abnormal lesion FFRct increased with increase of stenosis severity across each stenosis category (25–49%:6%; 50–69%:30%; 70–89%:54%; 90–99%:91%, p ​< ​0.001). Univariable analysis demonstrated that stenosis severity, LAP, and PR were predictive of abnormal lesion FFRct, while SC was not. In multivariable analyses considering stenosis severity, presence of PR, LAP, and PR and/or LAP were independently associated with abnormal FFRct: Odds ratio 1.58, 1.68, and 1.53, respectively (p ​< ​0.02 for all). The presence of PR and/or LAP increased the frequency of abnormal FFRct with mild stenosis (p ​< ​0.05) with a similar trend with 70–89% stenosis. The combination of 2 HRP (LAP and PR) identified more lesions with FFR < 0.80 than only 1 HRP. ConclusionsSemiquantitative visual assessment of high-risk plaque features may improve the selection of studies for FFRct.

Diagnostic Criteria and LI-RADS for Hepatocellular Carcinoma.

Diagnostic Criteria and LI-RADS for Hepatocellular Carcinoma.

The incidence of brain lesions in central precocious puberty: The main cause for Chinese boys was idiopathic.

ObjectiveMany studies show that brain lesions are the main cause of central precocious puberty (CPP) in males. However, the association rate has not been reported in China. This study aimed to assess the frequency of both abnormal and likely pathologic brain lesions by magnetic resonance imaging (MRI) in Chinese boys with CPP.DesignThis is a retrospective cross‐sectional single‐centre study.Patients396 CPP boys were recruited from 2011 to 2019 in Children's Hospital, Zhejiang University School of Medicine, and 129 were eligible for our study.MeasurementsDiagnosis age, bone age, weight (kg), height (cm), puberty stage, MRI results and levels of sexual hormone were analysed.ResultsThe number of CPP boys is increasing from 2011 to 2019 in China. Brain MRI findings were normal in 83.7% of CPP boys. Only 21 (16.3%) CPP boys were found with abnormal MRI findings including hamartoma, pineal cyst and other minor changes.ConclusionIn China, there is an increasing trend of male CPP over the last decade and the main cause is idiopathic, rather than pathogenic brain lesions. Further investigations about the aetiology for CPP with pathological brain lesions are needed.

English

BACKGROUND The major cause of mortality among women is cancer of the uterine cervix. It is the second most common cancer worldwide. Pap smear is done as a method of cervical screening to detect precancerous and cancerous lesions of the cervix. Early detection of these lesions prevent the number of deaths from cervical cancer. Liquid based cervical cytology was developed to improve the diagnostic accuracy of pap smears. The main purpose of this study was to compare the profile of distribution of cervical smear cytology lesions obtained by thin prep preparation (liquid based cytology) and conventional pap method among women in the age group of 25 – 60 yrs. METHODS This is a cross sectional study done among 110 women from the outpatient department of Obstetrics and Gynaecology. Conventional and liquid based cytology smears were taken simultaneously from the same women and reported according to the 2001 Bethesda system. RESULTS Majority of the women included in this study fall in the age group of 41 - 50 years [65 (59.1 %)]. Women with a history of persistant vaginal infection were 13 (11.8 %). Out of the 110 pap smears taken by both conventional and liquid based methods, unsatisfactory smears were not detected in liquid based cytology and 6 (5.5 %) unsatisfactory smears were found in conventional pap method. In liquid based cytology, inflammatory smears were detected more (80 %), atrophic smears (2.7 %), smears with features of atypical squamous cells of undetermined significance (ASCUS) were 4.5 %, low-grade squamous intraepithelial lesion (LSIL) were 3.6 %, and smears with high-grade squamous intraepithelial lesion (HSIL) were 0.9 %. Epithelial cell abnormalities were found to be high in liquid based cytology. CONCLUSIONS Abnormal epithelial lesions were detected more in liquid based cytology (thin prep method). The number of unsatisfactory smears were found to be decreased when compared to conventional pap method. KEY WORDS Bethesda Cervical Cytology, Cervical intraepithelial lesion, Conventional Pap Smear, Liquid Based Cytology Smear

Efficacy of ultrasonography and Tc-99m MIBI SPECT/CT in preoperative localization of parathyroid adenomas causing primary hyperthyroidism

BackgroundPrimary hyperparathyroidism (PHPT) results from an excess of parathyroid hormone (PTH) produced from an overactive parathyroid gland. The study aimed to explore the sonographic features of parathyroid adenomas and assess the diagnostic performance of ultrasonography (US) and Tc-99m MIBI SPECT/CT for preoperative localization of parathyroid adenomas.MethodsA total of 107 patients were enrolled in this retrospective study who had PHPT and underwent parathyroidectomy. Of the 107 patients, 97 performed US and Tc-99m MIBI SPECT/CT examinations for preoperative localization of parathyroid nodules. The sensitivity and accuracy of each modality were calculated.ResultsIn this study, residual parathyroid sign and polar vascular sign were identified as characteristic US features of parathyroid adenomas. These manifestations were closely related to the size of the abnormal parathyroid lesions. Among the 108 parathyroid nodules from 97 patients with PHPT, the sensitivity and accuracy of US for locating the parathyroid nodules were significantly higher than those of Tc-99m MIBI SPECT/CT (93.0% vs. 63.0% and 88.0% vs. 63.0% respectively; χ2 = 26.224, 18.227 respectively, P < 0.001). The differences between US + Tc-99m MIBI SPECT/CT and Tc-99m MIBI SPECT/CT-alone were statistically significant (χ2 = 33.410, 21.587 respectively, P < 0.001), yet there were no significant differences in the sensitivity or accuracy between US + Tc-99m MIBI SPECT/CT and US-alone (χ2 = 0.866, 0.187 respectively, P = 0.352 and 0.665).ConclusionsUS shows significantly better sensitivity and accuracy for localization of parathyroid adenomas than Tc-99m MIBI SPECT/CT. However, US combined with Tc-99m MIBI SPECT/CT is of great clinical value in the preoperative localization of parathyroid nodules in patients with PHPT.