Ancillary Imaging Research Articles

Optic disc and peripapillary tumors

Abstract This review covers the tumors either originating or seen close to the optic disc in the peripapillary area. Most of the optic disc tumors are diagnosed on clinical examination. In a few atypical cases, ancillary imaging, such as optical coherence tomography, fluorescein angiography, and ultrasonography, may be required to demonstrate characteristic features. The majority of these tumors have systemic associations, and hence, a multidisciplinary approach involving ocular oncologists, neurophysicians, radiation oncologists, and medical oncologists is the need of the hour. The treatment of optic disc tumor is challenging due to its proximity to critical areas such as optic nerve and macula, which could be a limiting step when compared to conventional treatments such as laser photocoagulation and surgical excision.

Unmasking biases and navigating pitfalls in the ophthalmic artificial intelligence lifecycle: A narrative review.

Over the past 2 decades, exponential growth in data availability, computational power, and newly available modeling techniques has led to an expansion in interest, investment, and research in Artificial Intelligence (AI) applications. Ophthalmology is one of many fields that seek to benefit from AI given the advent of telemedicine screening programs and the use of ancillary imaging. However, before AI can be widely deployed, further work must be done to avoid the pitfalls within the AI lifecycle. This review article breaks down the AI lifecycle into seven steps-data collection; defining the model task; data preprocessing and labeling; model development; model evaluation and validation; deployment; and finally, post-deployment evaluation, monitoring, and system recalibration-and delves into the risks for harm at each step and strategies for mitigating them.

Beyond transfer learning: Leveraging ancillary images in automated classification of plankton

AbstractWe assess whether a supervised machine learning algorithm, specifically a convolutional neural network (CNN), achieves higher accuracy on planktonic image classification when including non‐plankton and ancillary plankton during the training procedure. We focus on the case of optimizing the CNN for a single planktonic image source, while considering ancillary images to be plankton images from other instruments. We conducted two sets of experiments with three different types of plankton images (from a Zooglider, Underwater Vision Profiler 5, and Zooscan), and our results held across all three image types. First, we considered whether single‐stage transfer learning using non‐plankton images was beneficial. For this assessment, we used ImageNet images and the 2015 ImageNet contest‐winning model, ResNet‐152. We found increased accuracy using a ResNet‐152 model pretrained on ImageNet, provided the entire network was retrained rather than retraining only the fully connected layers. Next, we combined all three plankton image types into a single dataset with 3.3 million images (despite their differences in contrast, resolution, and pixel pitch) and conducted a multistage transfer learning assessment. We executed a transfer learning stage from ImageNet to the merged ancillary plankton dataset, then a second transfer learning stage from that merged plankton model to a single instrument dataset. We found that multistage transfer learning resulted in additional accuracy gains. These results should have generality for other image classification tasks.

Diffusely Infiltrative Small Bowel Disease.

Multiple infiltrative disorders can affect the small bowel, often resulting in diffuse small bowel wall thickening. These infiltrative disorders can manifest owing to various factors such as an influx of immunologic or neoplastic cells or the accumulation of substances within one or more layers of the intestinal wall. Although there can be considerable overlap in the appearances of infiltrative diseases on cross-sectional images, a comprehensive understanding of more specific ancillary imaging features and clinicopathologic correlation can substantially narrow the differential diagnosis. The radiologist can be instrumental in synthesizing the clinical and imaging information and guiding subsequent workup. The authors present a comprehensive review of the infiltrative disorders that commonly involve the small bowel. These disorders are organized on the basis of their pathophysiologic features, with multiple illustrative case examples to enhance understanding of these entities. CT and MRI are currently the most commonly used imaging modalities for evaluating small bowel disorders, and this review is focused on these two modalities. Detailed information regarding the pathologic features, clinical presentation, and imaging findings of these infiltrative disorders is provided to aid radiologists in recognizing and differentiating these conditions. ©RSNA, 2024.

LI-RADS v2018 category and imaging features: inter-modality agreement between contrast-enhanced CT, gadoxetate disodium-enhanced MRI, and extracellular contrast-enhanced MRI.

To perform an intra-individual comparison of LI-RADS category and imaging features in patients at high risk of hepatocellular carcinoma (HCC) on contrast-enhanced CT, gadoxetate disodium-enhanced MRI (EOB-MRI), and extracellular agent-enhanced MRI (ECA-MRI) and to analyze the diagnostic performance of each imaging modality. This retrospective study included cirrhotic patients with at least one LR-3, LR-4, LR-5, LR-M or LR-TIV observation imaged with at least two imaging modalities among CT, EOB-MRI, or ECA-MRI. Two radiologists evaluated the observations using the LI-RADS v2018 diagnostic algorithm. Reference standard included pathologic confirmation and imaging criteria according to LI-RADS v2018. Imaging features were compared between different exams using the McNemar test. Inter-modality agreement was calculated by using the weighted Cohen's kappa (k) test. A total of 144 observations (mean size 34.0 ± 32.4mm) in 96 patients were included. There were no significant differences in the detection of major and ancillary imaging features between the three imaging modalities. When considering all the observations, inter-modality agreement for category assignment was substantial between CT and EOB-MRI (k 0.60; 95%CI 0.44, 0.75), moderate between CT and ECA-MRI (k 0.46; 95%CI 0.22, 0.69) and substantial between EOB-MRI and ECA-MRI (k 0.72; 95%CI 0.59, 0.85). In observations smaller than 20mm, inter-modality agreement was fair between CT and EOB-MRI (k 0.26; 95%CI 0.05, 0.47), moderate between CT and ECA-MRI (k 0.42; 95%CI -0.02, 0.88), and substantial between EOB-MRI and ECA-MRI (k 0.65; 95%CI 0.47, 0.82). ECA-MRI demonstrated the highest sensitivity (70%) and specificity (100%) when considering LR-5 as predictor of HCC. Inter-modality agreement between CT, ECA-MRI, and EOB-MRI decreases in observations smaller than 20 mm. ECA-MRI has the provided higher sensitivity for the diagnosis of HCC.

More Is Actually Less: Practitioners' Perspective of Unnecessary Medical Testing in Saudi Arabian Emergency Departments.

Background Theoveruse of medical testing, be it ancillary testing or imaging, has been identified as a problem in all healthcare systems in the world. As the Kingdom of Saudi Arabia marches towards the 2030 vision of healthcare transformation, we have sought to get a perspective on medically unnecessary tests being conducted in Saudi Arabian emergency departments (EDs), the reasons behind this phenomenon, and possible solutions to it. Methods This is a cross-sectional survey among emergency medicine physicians (EMPs) working in Saudi Arabian EDs, taken through a self-filled online questionnaire, about their ordering habits, what they believe to be unnecessary testing in their practice, the practice of their colleagues, and other Saudi EMPs as a whole. Subjects have also been asked about the reasons why such practices are occurring and possible solutions to reduce such overuse of unnecessary tests in Saudi EDs. Results A total of 182 EMPs were surveyed from the different regions of the Kingdom, and CT head for patients presenting with asymptomatic stroke, and asymptomatic TBI were the most overused scans (both 44%). The most overused advanced body imaging was CT kidney-ureters-bladder (KUB) at 41.5%, while the most overused ancillary tests were complete blood count (CBC) and liver transaminases. The most common reason for the practice was found to be fear of medicolegal proceedings (70.9%). Continuous education of EMPs and increasing ED staffing were found to be the most helpful solutions to reduce unnecessary testing in the ED (70.9% and 67%, respectively). Conclusion It is clear from our data that overuse of medical tests and imaging is still a prominent practice. CT head in asymptomatic patients seems to be the most commonly overused imaging in Saudi EDs. Ancillary testing and unnecessary ordering of CBCs and transaminases seem to stem from fear of EMPs from legal consequences. More control over medical test ordering needs to be exercised to reduce these practices.

Iris freckle: a distinct entity

PurposeTo report distinctive clinical and imaging features of iris freckles to differentiate them from iris nevi.DesignRetrospective observational study.Subjects53 patients (277 freckles) with incidental iris freckles and 102 patients (104 nevi)...

Current trends in the management of corneal neovascularization.

The aim of this study was to highlight recent developments in the medical and surgical management of corneal neovascularization (NV). Improved understanding and diagnostic criteria among clinicians have led to advancements in the characterization of corneal NV and objective assessment of treatment response through ancillary imaging devices. Developments in corneal NV treatments, such as antivascular endothelial growth factor, fine needle diathermy, and photodynamic therapy, have improved treatment success rates and visual outcomes. More recent surgical treatment advancements include corneal cross-linking, endothelial keratoplasty, and mitomycin intravascular chemoembolization. Finally, a greater appreciation of the molecular pathogenesis and angiogenic factors involved in corneal NV has identified numerous potential targeted therapies in the future. The management of corneal NV has evolved to include several standalone and combination medical and surgical options. Additionally, improvements in quantifying corneal NV and understanding its molecular basis have contributed to new management strategies with improved outcomes.

The Role of Radionuclide Imaging in Brain Death Diagnosis.

Brain death is defined as the complete and irreversible cessation of the entire brain function, including the brainstem. For the most part, the diagnosis is clinical, and ancillary testing is only needed when clinical criteria are not satisfied. Differences exist in brain death diagnosis policy in the confirmation of brain death with ancillary testing and the particular test used. Demonstration of the absence of cerebral circulation is a reliable indicator of brain death. Currently, there are no agreed-on universal criteria for ancillary imaging investigation. However, several guidelines and meta-analyses have referred to radionuclide imaging as the most reliable, accurate, and validated ancillary imaging procedure in the confirmation of brain death. Whenever available, lipophilic agents should be preferred using tomographic imaging in all or as needed. False results may occur because of slight temporal delays in flow-function interaction, and such findings may carry prognostic information. Detectable cerebral circulation in the clinical presence of brain death most probably indicates that the process of dying is not yet complete. The results of radionuclide studies may also suggest that the loss of viability in a significant proportion of brain tissue is not compatible with life.

Role of optical coherence tomography angiography in diagnosis and management of inflammatory choroidal neovascular membrane in multifocal choroiditis – A case report

A 32-year-old male presented with decreased vision in the left eye. Fundus examination revealed healed multifocal choroiditis (MFC) and a juxtafoveal subretinal bleed. Optical coherence tomography (OCT) revealed streak subretinal fluid (SRF) and subretinal hyperreflective material (SHRM) at the macula. Fluorescein angiography (FA) showed a small area of faint hyperfluorescence adjacent to a choroiditis scar, amidst background scarring. Optical coherence tomography angiography (OCTA) detected type 2 choroidal neovascular membrane (CNV). A detailed clinical examination with appropriate ancillary imaging helps in detection of inflammatory CNV. OCTA may be superior to FA in detection of these neovascular membranes in certain case scenarios.

Ultrasound Biomicroscopy and echogenic external marker assisted Intraocular Foreign Body Removal.

We report a novel method of intra-operative localization of a retained anterior intraocular foreign body (IOFB), using a combination of ultrasound biomicrosopy (UBM) and an insulated needle. A retrospective case report of 56-year-old male who presented with a right eye IOFB. On presentation, vision was decreased in the right eye to count fingers with a small subconjunctival hemorrhage but no other signs of a penetrating laceration. Orbital CT revealed an IOFB and the initial vitrectomy failed to retrieve the IOFB. Then during the subsequent vitrectomy, using an ultrasound compatible needle and a UBM, we were able to precisely locate and remove the small anterior IOFB. Retained IOFBs can lead to severe irreversible vision loss if not promptly removed. Ancillary imaging modalities and localization techniques can help locate occult IOFBs in difficult cases.

Oral Cavity Squamous Cell Carcinoma: Review of Pathology, Diagnosis, and Management.

Squamous cell carcinoma of the oral cavity presents a significant global health burden, primarily due to risk factors such as tobacco smoking, smokeless tobacco use, heavy alcohol consumption, and betel quid chewing. Common clinical manifestations of oral cavity cancer include visible lesions and sores, often accompanied by pain in advanced stages. Diagnosis relies on a comprehensive assessment involving detailed history, physical examination, and biopsy. Ancillary imaging studies and functional evaluations aid in accurate staging and facilitate treatment planning. Prognostic information is obtained from histopathological factors, such as tumor grade, depth of invasion, lymphovascular invasion, and perineural invasion. Notably, lymph node metastasis, found in approximately half of the patients, carries significant prognostic implications. Effective management necessitates a multidisciplinary approach to optimize patient outcomes. Surgical resection is the backbone of treatment, aimed at complete tumor removal while preserving functional outcomes. Adjuvant therapies, including radiation and chemotherapy, are tailored according to pathological factors. Further work in risk stratification and treatment is necessary to optimize outcomes in squamous cell carcinoma of the oral cavity.

Current Status of Imaging Diagnosis and Treatment of Subcentimeter Hepatocellular Carcinoma

Abstract: Significant advances in liver imaging technology have facilitated the early detection of subcentimeter hepatocellular carcinoma (HCC). Contrast-enhanced ultrasound, computed tomography, and magnetic resonance imaging (MRI) can be used to diagnose subcentimeter HCC based on the typical imaging features of HCC. Ancillary imaging features such as T2 weightedimaging mild-moderate hyperintensity, restricted diffusion, and hepatobiliary phase hypointensity may improve the diagnostic accuracy of gadoxetic acid-enhanced MRI for subcentimeter HCC. More information is needed to choose between immediate treatment or watchful waiting in subcentimeter HCC. Surgical resection, ablation, and transarterial chemoembolization are effective and safe methods for the management of subcentimeter HCC.

Multiple Primary Melanoma: A Five-Year Prospective Single-Center Follow-Up Study of Two MC1R R/R Genotype Carriers.

Multiple primary melanoma (MPM) is a diagnostic challenge even with ancillary imaging technologies available to dermatologists. In selected patients' phenotypes, the use of imaging approaches can help better understand lesion characteristics, and aid in early diagnosis and management. Under a 5-year prospective single-center follow-up, 58 s primary melanomas (SPMs) were diagnosed in two first-degree relatives, with fair skin color, red hair, green eyes, and personal history of one previous melanoma each. Patients' behavior and descriptive demographic data were collected from medical records. The information on the first two primary melanomas (PMs) were retrieved from pathology reports. The characteristics of 60 melanomas were collected from medical records, video dermoscopy software, and pathology reports. Reflectance confocal microscopy (RCM) was performed prior to excision of 22 randomly selected melanomas. From February 2018 to May 2023, two patients underwent a pooled total of 214 excisional biopsies of suspect lesions, resulting in a combined benign versus malignant treatment ratio (NNT) of 2.0:1.0. The number of moles excised for each melanoma diagnosed (NNE) was 1.7:1.0 and 6.9:1.0 for the female and male patient respectively. The in-situ melanoma/invasive melanoma ratio (IIR) demonstrated a higher proportion of in-situ melanomas for both patients. From June 2018 to May 2023, a total of 58 SPMs were detected by the combination of total body skin exam (TBSE), total body skin photography (TBSP), digital dermoscopy (DD), and sequential digital dermoscopy imaging (SDDI) via comparative approach. The younger patient had her PM one month prior to the second and third cutaneous melanomas (CMs), characterizing a case of synchronous primary CM. The male older relative had a total of 7 nonsynchronous melanomas. This CM cohort is composed of 83.3% in-situ melanoma and 16.7% invasive melanoma. Both patients had a higher percentage of SPM with clinical nevus-like morphology (84.5%), global dermoscopic pattern of asymmetric multiple component (60.3%) and located on the lower limbs (46.6%). When RCM was performed prior to excision, 81% of SPM had features suggestive of malignancy. As well, invasive melanomas were more frequent in the lower limbs (40%). In the multivariate model, for the two high-risk patients studied, the chance of a not associated with nevus ("de novo") invasive SPM diagnosis is 25 times greater than the chance of a diagnosis of a nevus-associated invasive SPM.

Vitreoretinal Specialist Use of Ancillary Testing: An IRIS® Registry Analysis.

To investigate patterns of ancillary imaging testing among vitreoretinal specialists for patients with vitreoretinal disease in the United States (US). Optical coherence tomography (OCT), color fundus photography (CFP), and fluorescein angiography (FA), ordered by vitreoretinal specialists and documented within the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) between 01 January 2018 and 31 December 2020, were retrospectively assessed. Trends in imaging modality choice were analyzed by payer type, geographic region, and practice type. Sub-analyses were conducted according to categorization of vitreoretinal specialists into those treating a high versus low volume of patients with neovascular age-related macular degeneration (nAMD). OCT was the most common imaging modality used, followed by CFP and FA. Following normalization, the highest volume of OCT procedures performed were identified among Medicare Advantage and Medicare Fee-for-Service beneficiaries, within the South of the US, and at medium and large practices. Minimal differences were observed for CFP and FA volume across payer types and regions. Across practice types, the largest volume of CFP and FA procedures were identified in small and private equity owned practices, respectively. Vitreoretinal specialists with a high nAMD volume more frequently performed OCT than those with a low nAMD volume. Vitreoretinal specialists demonstrated a strong preference for OCT, with real-world associations according to payer type, geographic location, and practice type. Volume of nAMD patients seen impacted the likelihood of specialists ordering OCTs.

The Study of Intelligent Image Classification Systems: An Exploration of Generative Adversarial Networks with Texture Information on Coastal Driftwood

Taiwan is located at the junction of plates in which the stratum is relatively unstable, resulting in frequent earthquakes. Driftwood has always been regarded as a precious asset that enables ecoscientists to track earthquakes. In the event of a typhoon or heavy rain, the surface water flows to flush the woods from the hills to the coast. More specifically, a large rainfall or earthquake may cause floods and collapses, and the trees in the forest will be washed down. Therefore, this study used high-resolution images to build an image database of the new north coast of Taiwan, and a deep learning approach is incorporated to classify the driftwoods. To improve the interpretation of driftwood in the remote images, we initially import eight pieces of textured information which are employed to the raw bands (B, G, R, and IR). The usage of spatial information image extraction technology is incorporated into a deep learning analysis using two parallel approaches. The generative adversarial network (GAN) is used to analyze the color images alongside an ancillary image with texture information. Most of the salt–pepper effects are produced by applying a high-resolution thematic map, and an error matrix is generated to compare the differences between them. The raw data (original R + G + B + IR) images, when analyzed using GAN, have about 70% overall classification outcomes. Not all of the driftwood can be detected. By applying the texture information to the parallel approach, the overall accuracy is enhanced to 78%, and about 80% of the driftwood can be recognized.

Brain Death Confirmation by 18F-FDG PET/CT: A Case Series.

Brain death is a state of irreversible loss of brain function in the cortex and brainstem. Diagnosis of brain death is established by clinical assessments of cranial nerves and apnea tests. Different conditions can mimic brain death. In addition, confirmatory tests may be falsely positive in some cases. In this study, we aimed to evaluate the role of positron emission tomography-computed tomography scan with 2-deoxy-2[18F]fluoro-D-glucose (18F-FDG-PET/CT) as an ancillary test in diagnosing brain death. We analyzed 6 potential brain death donors for the confirmatory diagnosis of brain death using FDG-PET/CT. All 6 donors were brain dead by clinical criteria. All patients had electroencephalogram and brain computed tomography. Other than FDG-PET/CT, transcranial Doppler was performed in 1 patient, with other patients having no confirmatory ancillary imaging tests. Patients had nothing by mouth for 6 hours before imaging. Patients were supine in a semi-dark, noiseless, and odorless room with closed eyes. After 60 minutes of uptake,the brain PET/CT scan was performed with sequential time-of-flight-PET/CT (Discovery 690 PET/CT with 64 slices, GE Healthcare). The PET scan consisted of LYSO (Lu1.8Y0.2 SiO5) crystals with dimensions of 4.2 × 6.3 × 25 mm3. Three-dimension images were with scan duration of 10 minutes. The PET scan confirmed brain death in 5 of the 6 cases. However, we ruled out brain death using PET/CT in a 3-year-old child, although all clinical tests confirmed brain death. A PET scan illustrates a hollow skull phenomenon suggestive of brain death. It can be a powerful diagnostic tool to assess brain death.

CT MRI LI-RADS in Routine Practice

AbstractPrimary liver cancer is the third most common cause of cancer-related deaths worldwide with hepatocellular carcinoma (HCC) comprising the vast majority of the cases. HCC unlike most solid cancers can be diagnosed based on imaging findings alone using multiphasic contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) without the need for histopathological confirmation in the majority of the cases. Liver Imaging Reporting and Data System (LI-RADS) was first introduced by the American College of Radiology in 2011 with the help of a multidisciplinary team of liver disease experts to improve the accuracy, consistency, and clarity of communication of imaging findings between radiologists and treating physicians. To date, LI-RADS has undergone four major updates in 2013, 2014, 2017, and 2018. This article reviews the technical aspects, categorization, and major and ancillary imaging features for the application of LI-RADS version 2018 using CT and MRI in routine clinical practice.

Optical Coherence Tomography–Guided Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: Rationale and Design of the ATLAS-OCT Study

Even after successful revascularization with primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), subsequent adverse events still occur. Previous studies have suggested potential benefits of intravascular imaging, including optical coherence tomography (OCT). However, the feasibility of OCT-guided primary PCI has not been systematically examined in these patients. The ATLAS-OCT (ST-elevation Acute myocardial infarcTion and cLinicAl outcomeS treated by Optical Coherence Tomography-guided percutaneous coronary intervention) trial was designed to investigate the feasibility of OCT guidance during primary PCI for STEMI in experienced centers with expertise on OCT-guided PCI as a prospective, multicenter registry of consecutive patients with STEMI who underwent a primary PCI. The sites' inclusion criteria are as follows: (1) acute care hospitals providing 24/7 emergency care for STEMI, and (2) institutions where OCT-guided PCI is the first choice for primary PCI in STEMI. All patients with STEMI who underwent primary PCI at participating sites will be consecutively enrolled, irrespective of OCT use during PCI. The primary end point will be the rate of successful OCT imaging during the primary PCI. As an ancillary imaging modality to angiography, OCT provides morphologic information during PCI for the assessment of plaque phenotypes, vessel sizing, and PCI optimization. Major adverse cardiac events, defined as a composite of all-cause death, myocardial infarction, and target vessel revascularization at 1year, will also be recorded. The ATLAS-OCT study will clarify the feasibility of OCT-guided primary PCI for patients with STEMI and further identify a suitable patient group for OCT-guided primary PCI.

Choroidal Melanoma in an Asymptomatic Patient

Introduction Choroidal melanoma is considered the most common intraocular malignancy found in adults and typically presents without symptoms in the early stages. They are frequently first seen on routine dilated fundoscopic exams and appear as a pigmented or nonpigmented choroidal lesion. Case Presentation A 58-year-old Caucasian female presented for a comprehensive eye exam with a chief complaint of gradual distance blur in both eyes. On funduscopic examination of the right eye, a suspicious faint, variably pigmented large choroidal lesion was noted adjacent to the optic nerve. The patient was referred to a retinal oncologist for further workup and management. Management and Outcome The retinal oncologist performed multiple imaging tests including B-scan ultrasound, OCT, and Fundus Autofluorescence which revealed a choroidal mass with subretinal fluid, and presence of lipofuscin confirming a diagnosis of a small choroidal melanoma. Systemic workup did not reveal any metastasis of the choroidal lesion. The patient was initially treated surgically with plaque radiotherapy; however, the patient developed ocular complications ultimately leading to enucleation of the right eye. Consequently, the patient was fitted with an ocular prosthesis. Discussion Choroidal melanomas are the most common intraocular malignancy found in adults and encompass 80% of all uveal melanomas. Patients with choroidal melanoma are typically asymptomatic and are commonly first seen on routine dilated fundoscopic exams. Metastasis of choroidal melanomas are rare but can occur in 1-2% of all cases mainly to the liver, bone, and lung. A 50% mortality rate in a 10-year span has been noted for metastasized choroidal melanomas. Ancillary imaging modalities such as Optical coherence tomography, Fundus Autofluorescence, and B-scan ultrasound are useful in aiding in the diagnosis. Treatment and management are modified based on the characteristics of the tumor and patient, which can include brachytherapy, external beam radiotherapy, stereotactic radiotherapy, transpupillary thermotherapy, and enucleation. Timely detection and treatment are key in managing this sight and life-threatening illness CE Notification This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/choroidal-melanoma-in-an-asymptomatic-patient) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.