Border Delineation Research Articles

Wearing Trauma on Her Sleeve: A Jumlo as a Witness and Recorder of Colonial Boundaries

The RISD Museum recently displayed a jumlo (dress) made by a Nuristani woman, an ethnic group native to land that borders modern-day Afghanistan and Pakistan. The jumlo shows a deep connection to the geographic and cultural past of the region, with traditional embroidered solar and geometric motifs that mirror local pre-Islamic rock art. The textile also reveals how the maker is embedded in the cultural transitions of the mid-twentieth century, displaying coins that date from both before and after the British partition of India. As the British, Indian, Afghan, and Pakistani political interests were all involved in the delineation of political borders in the wake of British colonialism’s collapse, the shifting and dividing boundaries left a traumatic legacy visible in the material culture. Now part of a museum collection, the jumlo continues to find these political borders unstable; as it—and other textiles from the same people—are variously labeled as Nuristani, Kohistani, Pakistani, Afghan, Indian, or Dardic. This continued confusion of attributions replicates and risks reinscribing the trauma of the imposition of political boundaries without regard to the cultural, geographical, and historical realities of the women who made the garment. Over 70 years later, this jumlo acts as a witness and documentor of violent processes in Central and South Asia, and can perhaps spark dialogue on personal choices, lives, and trauma within the area today.

Comparison of two ultrasound contrast agents for left ventricular opacification

Abstract Funding Acknowledgements Type of funding sources: None. Background Several ultrasound contrast agents have been approved and used for measurement of LV volumes and ejection fraction (EF). However, there has been no direct comparison between these agents. Purpose To compare different imaging parameters between two widely used ultrasound contrast agents for LV opacification when imaged with a low power contrast specific imaging modality Methods A retrospective study was performed using recordings of the local echocardiography registry for patients undergoing chemotherapy for cancer treatment. Patients were included who underwent follow-up echocardiograms (3 months) with 2 different ultrasound contrast agents and had only minor changes in the LV ejection fraction (EF) between the studies (<5%). Qualitative and quantitative analysis of the contrast effect was performed in apical four- and two chamber views (4CV,2CV). For quantitative analysis of the LV opacification square regions of interest (ROI) were placed in the apical and basal regions of the ventricle in each echocardiographic recording and the arithmetic mean and standard deviation of pixel intensity within each ROI was recorded throughout the entire loop. Qualitative visual assessment was performed using a three step visual score in order to assess the endocardial border delineation, basal attenuation and apical swirling. Wilcoxon signed-rank test was used to compare the measurements obtained with different contrast agents. Results 41 patients fulfilled the inclusion criteria. In all patients suitable recordings for measurement of LV volumes and EF were obtained. The mean + standard deviation of the EF was 61 + 9%. Both contrast agents provided intensive LV opacification in the basal and apical cavities. The video intensities (mean + standard deviation) in the apical and basal cavities were comparable across both contrast agents in the 2CV apical ROI (219.96 + 21.42 vs 224.69 + 20.23, p = 0.32), the 2CV basal ROI (114.55, 42.02 vs 112.79, 42.57, p = 0.81), the 4CV apical ROI (228.02, 17.80 vs 225.51, 20.37, p = 0.30), and the 4CV basal ROI (100.05, 41.11 vs 92.84, 42.54, p = 0.37). Visual assessment of endocardial delineation on end-diastolic and end-systolic frames revealed no statistical difference between the contrast agents. Conclusion In patients with normal LV function no clinically relevant differences were found between the two contrast agents regarding LV opacification and endocardial border delineation.

The Impact of Semiautomatic Segmentation Methods on Metabolic Tumor Volume, Intensity, and Dissemination Radiomics in 18F-FDG PET Scans of Patients with Classical Hodgkin Lymphoma.

Consensus about a standard segmentation method to derive metabolic tumor volume (MTV) in classical Hodgkin lymphoma (cHL) is lacking, and it is unknown how different segmentation methods influence quantitative PET features. Therefore, we aimed to evaluate the delineation and completeness of lesion selection and the need for manual adaptation with different segmentation methods, and to assess the influence of segmentation methods on the prognostic value of MTV, intensity, and dissemination radiomics features in cHL patients. Methods: We analyzed a total of 105 18F-FDG PET/CT scans from patients with newly diagnosed (n = 35) and relapsed/refractory (n = 70) cHL with 6 segmentation methods: 2 fixed thresholds on SUV4.0 and SUV2.5, 2 relative methods of 41% of SUVmax (41max) and a contrast-corrected 50% of SUVpeak (A50P), and 2 combination majority vote (MV) methods (MV2, MV3). Segmentation quality was assessed by 2 reviewers on the basis of predefined quality criteria: completeness of selection, the need for manual adaptation, and delineation of lesion borders. Correlations and prognostic performance of resulting radiomics features were compared among the methods. Results: SUV4.0 required the least manual adaptation but tended to underestimate MTV and often missed small lesions with low 18F-FDG uptake. SUV2.5 most frequently included all lesions but required minor manual adaptations and generally overestimated MTV. In contrast, few lesions were missed when using 41max, A50P, MV2, and MV3, but these segmentation methods required extensive manual adaptation and overestimated MTV in most cases. MTV and dissemination features significantly differed among the methods. However, correlations among methods were high for MTV and most intensity and dissemination features. There were no significant differences in prognostic performance for all features among the methods. Conclusion: A high correlation existed between MTV, intensity, and most dissemination features derived with the different segmentation methods, and the prognostic performance is similar. Despite frequently missing small lesions with low 18F-FDG avidity, segmentation with a fixed threshold of SUV4.0 required the least manual adaptation, which is critical for future research and implementation in clinical practice. However, the importance of small, low 18F-FDG-avidity lesions should be addressed in a larger cohort of cHL patients.

Personality and territoriality in theory and in Belgium

AbstractLanguage policy debates regularly refer to the principles of personality and territoriality. Yet the precise meaning of these principles remains unclear. In this contribution, I conceptualize these principles as poles of a continuum between official bilingualism (instantiating the personality principle) and official unilingualism (exemplifying the territoriality principle), with a mixed regime in between (which grants a certain territorial primacy to a language, but allows exceptions based on linguistic affiliation). The question of the determination of particular points on the continuum cannot be separated from the metaterritorial question of the boundaries of the units within which those principles apply. Application of this ‘continuum model’ to Belgium draws attention to three language-political regimes. The first invokes a strict personality principle (Brussels). The second follows the strict territoriality principle (almost all municipalities in Flanders and Wallonia). The third is a mixed regime (a total of 27 ‘municipalities with facilities’ where one language enjoys primacy but speakers of another language enjoy certain linguistic ‘facilities’). The article also analyses the manner in which these regimes were historically established in Belgium in combination with a delineation of the language border and the division of the country into four language areas.

Abstract 14436: Effects of Uncertainty in Border Delineation on GLS BL versus LVEF

Background: There are many clinical scenarios in which early detection of small changes in cardiac function can be critical in determining a patient’s treatment. Two of the most common imaging-based metrics in the clinic are LVEF and border-length-based GLS (GLS BL ). The aim of this project was to analyze the inherent biases and uncertainties in GLS BL relative to LVEF with respect to uncertainties in delineation of the endocardial border. Methods: I n silico 3D human LV endocardial surface models were created at end-diastole and end-systole based on MRIs of a healthy human volunteer. Twelve virtual long-axis imaging slices (in a radially-prescribed) were projected through the surface models to generate noise-free endocardial contour points. To simulate border delineation uncertainty, the set of endocardial contour points was subjected to inward and outward shifts of 1-5 mm, incrementally (Fig 1A). The expected uncertainty when using EC is around 3 mm. The % error vs. offsets were calculated for bi-plane GLS BL , bi-plane area-length LVEF AL , and bi-plane method-of-disks LVEF MOD , with 3D conformal surface-fit LVEF SURF as ground-truth. Results: The GLS BL %error vs. offset was linear (R 2 = 1.000) with a slope of 4.92 (Fig. 1B). Each of the LVEF measures were quadratic with offset (R 2 = 1.000), with slopes: LVEF AL : 6.68; LVEF MOD : 6.71; and LVEF SURF : 10.26. Conclusions: GLS BL is less sensitive to boundary delineation uncertainty than LVEF, due to the linear vs. quadratic dependence on offset. LVEF AL and LVEF MOD consistently underestimate true LVEF, making them less sensitive to boundary uncertainty. However, if border uncertainty is negligible, then LVEF is more sensitive than GLS BL to small changes in LV volume, and LVEF SURF is more sensitive than either LVEF AL and LVEF MOD .

The odyssey to dethrone LV ejection fraction continues: the prognostic value of LV global function index in heart failure

Abstract Background Left Ventricular (LV) Global Function index (LVGFi) is a parameter that combines data from global systolic performance and volumetric anatomical information, measurable by non-contrast Cardiac Magnetic Resonance (CMR). We aimed to evaluate whether LVGFi predicts major cardiovascular outcomes and outperforms LV ejection fraction (LVEF) in Heart Failure (HF). Methods We conducted a retrospective single-centre study of consecutive patients with HF who were referred to and had a LVEF <50% at CMR. Other than inadequate images for endocardial or epicardial border delineation, there were no exclusion criteria. LVEF was determined by 3D measurement. LVGFi was calculated as the LV stroke volume to the LV global volume ratio (Figure 1). The primary endpoint was a composite of time to all-cause death or HF hospitalization. Results The cohort was comprised of 433 HF patients (mean age 64±12 years, 74.1% male, ischaemic HF 53.1%, NYHA I-II 83.9%) with a mean LVEF of 33.5±10.0% and LVGFi of 22.8±7.4%. Over a median follow-up of 27 (17–37) months, 85 (19.6%) met the primary endpoint and 42 (9.7%) died. Patients with an event of the primary endpoint had markers of more severe HF, as noted by a reduced functional capacity (NYHA I-II: 63.5 vs. 89.0%; p<0.001) and increased natriuretic peptides [NT-proBNP: 2664 (1022–27242) vs. 791 (337–7258); p<0.001). Likewise, CMR showed higher LV volumes (e.g., LV end-diastolic volume index: 137±50 vs. 120±43mL/m2; p=0.001) and reduced LV performance indices, namely LVEF (29.2±10.6 vs 34.5±9.6%; p<0.001) and LVGFi (19.8±7.4 vs 23.6±7.3%; p<0.001). Both LVEF and LVGFi independently predicted the primary endpoint in multivariate analysis (separately imputed into a model adjusted for NYHA, NT-proBNP and creatinine). The LVEF model was more powerful than that of LVGFi. Similarly, LVGFi did not provide incremental prognostic information over LVEF in c-statistics analysis (0.653 vs. 0.622; p=0.645) (Figure 2). Conclusion While LVGFi independently predicted major outcomes in patients with HF and LVEF <50%, it did not surpass LVEF. Our findings contrast to those demonstrating LVGFi as a powerful variable that outperforms LVEF in hypertrophic cardiomyopathy, cardiac amyloidosis, and healthy subjects at risk of developing structural heart disease. We hypothesize that LVGFi might be primarily useful in the prognostic stratification of patients with preserved LVEF. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Utility of transillumination and transparency renderings in 3D transthoracic imaging.

Transillumination (TI) is a new 3D rendering tool that uses a freely movable virtual light source to enhance depth, contours, and image detail. The TI model was recently modified to allow the operator adjust the degree of transparency of both cardiac and extra-cardiac structures. While the addition of transparency was shown to significantly improve quality in 3D transesophageal imaging, this has not yet been shown for transthoracic (TTE) imaging. We prospectively studied 35 patients who underwent clinically indicated TTE with standard 3D acquisition, as well as TI with and without transparency. Six experienced echocardiographers were shown images of all three display types in random order. Each image was scored independently using a Likert Scale while assessing each of the following aspects: ability to identify anatomy or pathology, depth perception, degree of anatomic detail, and border delineation. All experts perceived an incremental value of the transparency mode, compared to TI without transparency and standard 3D rendering, in terms of ability to identify anatomy or pathology (4.15 ± 0.97 vs. 3.88 ± 0.99 vs. 2.52 ± 1.41, p < 0.01), depth perception (4.33 ± 0.78 vs. 3.88 ± 0.82 vs. 2.29 ± 1.07, p < 0.01), degree of anatomic detail (4.08 ± 1.0 vs. 3.89 ± 0.79 vs. 2.31 ± 1.08, p < 0.01), and border delineation (4.44 ± 0.80 vs. 3.90 ± 0.78 vs. 2.42 ± 1.13, p < 0.01). Compared to standard 3D and TI renderings of TTE images, the addition of transparency significantly improves both image quality and diagnostic confidence.

Stress-echocardiography or coronary computed tomography in suspected chronic coronary syndrome after the 2019 European Guidelines? A practical guide.

Stress-echocardiography can rightly be considered one of the champions of cardiac functional imaging, thanks to its real-time imaging, high temporal resolution, high safety and very low cost. When stress-echocardiography is performed at top technical quality, hence taking advantage of ultrasound contrast media for endocardial border delineation at least for suboptimal cases, subjectivity is minimized, and with the routine use of coronary flow reserve measurement (left anterior descending coronary artery, stress/rest ratio reduced or normal, i.e. <>2.0) diagnostic sensitivity is strengthened. The true competitor of any type of functional imaging, stress-echocardiography included, is nowadays coronary computed tomography angiography, which is instead a diagnostic method directly, noninvasively assessing coronary anatomy, apparently the holy grail for any cardiologist. The new 2019 Guidelines on chronic coronary syndrome of the European Society of Cardiology change the existing landscape and clinical practice, while they probably cannot clarify which type of test, functional or anatomic, should be first chosen in different clinical scenarios of suspected chronic coronary syndrome. We review the existing data and the authors' personal view in order to assess how functional stress-echocardiography compares with coronary computed tomography angiography regarding three main aspects: diagnosis of coronary artery disease, guidance of therapy (coronary revascularization versus medical therapy) and risk stratification.

Association between mucin phenotype and lesion border detection using acetic acid-indigo carmine chromoendoscopy in early gastric cancers.

For successful treatment of early gastric cancers (EGCs), it is crucial to define the horizontal border of the lesion with high accuracy. Acetic acid-indigo carmine (AI) chromoendoscopy has been used to determine the horizontal border in EGCs, but this technique is less potent in certain situations. Mucin phenotype in gastric cancers refers to biological differences in precursor lesions and differences in histopathologic findings, and it might affect AI chromoendoscopy findings. We aimed to investigate the association between mucin phenotype and AI chromoendoscopy findings in EGCs. We prospectively evaluated 126 lesions in 126 patients with endoscopically diagnosed EGCs. Conventional endoscopy and AI chromoendoscopy findings of these lesions before treatment were prospectively analyzed. The border distinction between the lesion and surrounding mucosa was classified as distinct or indistinct on conventional endoscopy and AI chromoendoscopy, respectively. Mucin phenotypes were classified as gastric, intestinal, gastrointestinal, or null type by immunohistochemistry. The lesion borders were distinct in 46.8% (59/126) of the lesions assessed using conventional endoscopy and in 73.0% (92/126) of those assessed with AI chromoendoscopy (p < 0.001). The border distinction rate of differentiated-type cancers on AI chromoendoscopy was significantly higher than that on conventional endoscopy (66/71 [93.0%] vs. 34/71 [47.9%], p < 0.001), but the border distinction rate of undifferentiated-type cancers on AI chromoendoscopy was not different from that on conventional endoscopy (26/55 [47.3%] vs. 25/55 [45.5%], p = 0.848). Compared with conventional endoscopy, AI chromoendoscopy identified borders in a significantly higher percentage of gastric, intestinal, and gastrointestinal mucin types; however, there was no difference in AI chromoendoscopy findings according to the mucin phenotype (p = 0.271). AI chromoendoscopy was effective in horizontal border delineation in differentiated-type EGCs, but not in undifferentiated-type EGCs. Mucin phenotype had no effect on border distinction using AI chromoendoscopy.

Dose‐Lowering in Contrast‐Enhanced MRI of the Central Nervous System: A Retrospective, Parallel‐Group Comparison Using Gadobenate Dimeglumine

BackgroundConcerns over gadolinium (Gd) retention encourage the use of lower Gd doses. However, lower Gd doses may compromise imaging performance. Higher relaxivity gadobenate may be suited to reduced dose protocols.PurposeTo compare 0.05 mmol/kg and 0.1 mmol/kg gadobenate in patients undergoing enhanced MRI of the central nervous system (CNS).Study TypeRetrospective, multicenter.PopulationThree hundred and fifty‐two patients receiving 0.05 (n = 181) or 0.1 (n = 171) mmol/kg gadobenate.Field Strength/Sequences1.5 T and 3.0 T/precontrast and postcontrast T1‐weighted spin echo/fast spin echo (SE/FSE) and/or gradient echo/fast field echo (GRE/FFE); precontrast T2‐weighted FSE and T2‐FLAIR.AssessmentImages of patients with extra‐axial lesions at 1.5 T or any CNS lesion at 3.0 T were reviewed by three blinded, independent neuroradiologists for qualitative (lesion border delineation, internal morphology visualization, contrast enhancement; scores from 1 = poor to 4 = excellent) and quantitative (lesion‐to‐brain ratio [LBR], contrast‐to‐noise ratio [CNR]; SI measurements at regions‐of‐interest on lesion and normal parenchyma) enhancement measures. Noninferiority of 0.05 mmol/kg gadobenate was determined for each qualitative endpoint if the lower limit of the 95% confidence interval (CI) for the difference in precontrast + postcontrast means was above a noninferiority margin of −0.4.Statistical TestsStudent's t‐test for comparison of mean qualitative endpoint scores, Wilcoxon signed rank test for comparison of LBR and CNR values; Wilcoxon rank sum test for comparison of SI changes. Tests were significant for P < 0.05.ResultsThe mean change from precontrast to precontrast + postcontrast was significant for all endpoints. Readers 1, 2, and 3 evaluated 304, 225, and 249 lesions for 0.05 mmol/kg gadobenate, and 382, 309, and 298 lesions for 0.1 mmol/kg gadobenate. The lower limit of the 95% CI was above −0.4 for all comparisons. Significantly, higher LBR and CNR was observed with the higher dose.Data Conclusion0.05 mmol/kg gadobenate was noninferior to 0.1 mmol/kg gadobenate for lesion visualization.Evidence Level2Technical EfficacyStage 3

A Comparative Study of Scrotal Pathologies by Ultrasound and Their Correlation with CT and MRI

Background: The scrotum is a readily examinable structure clinically in normal conditions. However, in cases of swelling and tenderness, its clinical examination alone may not reveal any significant information. Therefore, imaging techniques such as ultrasound including CT and MRI may be required in cases. We in the current study tried to evaluate the role of ultrasound, CT, and MRI in the evaluation of scrotal pathologies. Methods: All the cases of scrotal pathologies referred from the Departments of Urology and General Surgery, were included in the study. All the patients were studied using Highfrequency real-time grayscale ultrasonography and Doppler. Before subjecting the patients for ultrasound examination, patient details, detailed clinical history was obtained along with thorough physical examination. The color Doppler sonography was routinely performed in all these patients. Subsequently, these cases were followed up and correlated with histopathology report, fine needle aspiration cytology results, surgical findings, response to treatment. Results: Out of n=50 cases studied most of the casesClinically presented with a combination of multiple symptoms wasscrotal swelling, as in n=18 cases (36%).Out of which n=30(60%) were unilateral and n=20(40%) werebilateral.Combination of pain, swelling, and fever in four cases (8%). The n=30 unilateral swelling showed n=14 cases of right-side involvement and n=16 cases of left-side involvement. Of n=5 cases of congenital anomaly associated with the descent of testes, n=2 cases were referred with clinical suspicion of incompletely descended testes, which were clinically palpable. 4% cases of scrotal and testicular trauma were detected. Among non-neoplastic scrotal swellings, hydrocele is the commonest pathology noted in n=9 cases. Epididymal cyst in n=2 cases, varicocele in n=6 cases. Conclusion: ultrasonography is best for the demonstration of morphological changes due to acute scrotal inflammation. The color doppler sonography can accurately differentiate between testicular ischemia and torsion from acute inflammatory diseases. High-frequency ultrasonography with Doppler is highly sensitive in demonstrating the varicoceles. MRI provides better delineation of borders, cystic components, and tissue signal intensities of the testicular masses. CT is the imaging modality of choice for detecting metastatic deposits

Detection of subthalamic nucleus using novel higher-order spectra features in microelectrode recordings signals

Successful deep brain stimulation surgery for Parkinson’s disease (PD) patients hinges on accurate clustering of the functional regions along the electrode insertion trajectory. Microelectrode recording (MER) is employed as a substantial tool for neuro-navigation and localizing the optimal target, such as the subthalamic nucleus (STN), intraoperatively. MER signals deliver a framework to reveal the underlying characteristics of STN. The motivation behind this work is to explore the application of Higher-order statistics and spectra (HOS) for an automated delineation of the neurophysiological borders of STN using MER signals. Database collected from 21 PD patients were used. Two HOS methods (Bispectrum and cumulant) were exploited to probe non-Gaussian properties of STN region. This is followed by utilizing classifiers, namely K-nearest neighbor, decision tree, Boosting and support vector machine (SVM), to choose the superior classifier. Comparison of the performance achieved via HOS alongside the state-of-the-art techniques shows that the proposed features are better suited for identifying STN borders and achieve higher results. Average classification accuracy, sensitivity, specificity, area under the curve and Youden’s J statistics of 94.81%, 96.73%, 92.15%, 0.9444% and 0.8888, respectively, were yielded using SVM with 8 bispectrum and 241 cumulants features. The proposed model can aid the neurosurgeon in STN detection.

Deep convolutional neural network for the automated detection of Subthalamic nucleus using MER signals

BackgroundDeep brain stimulation (DBS) surgery has been extensively conducted for treating advanced Parkinson's disease (PD) patient's symptoms. DBS hinges on the localization of the subthalamic nucleus (STN) in which a permanent electrode should be accurately placed to produce electrical current. Microelectrode recording (MER) signals are routinely recorded in the procedure of DBS surgery to validate the planned trajectories. However, manual MER signals interpretation with the goal of detecting STN borders requires expertise and prone to inter-observer variability. Therefore, a computerized aided system would be beneficial to automatic detection of the dorsal and ventral borders of the STN in MER. New methodIn this study, a new deep learning model based on convolutional neural system for automatic delineation of the neurophysiological borders of the STN along the electrode trajectory was developed. Comparison with existing methodsThe proposed model does not involve any conventional standardization, feature extraction or selection steps. ResultsPromising results of 98.67% accuracy, 99.03% sensitivity, 98.11% specificity, 98.79% precision and 98.91% F1-score for subject based testing were achieved using the proposed convolutional neural network (CNN) model. ConclusionsThis is the first study on the analysis of MER signals to detect STN using deep CNN. Traditional machine learning (ML) algorithms are often cumbersome and suffer from subjective evaluation. Though, the developed 10-layered CNN model has the capability of extracting substantial features at the convolution stage. Hence, the proposed model has the potential to deliver high performance on STN region detection which shows perspective in aiding the neurosurgeon intraoperatively.

T1 mapping-derived signature of myocardial involvement in idiopathic inflammatory myopathy compared to acute viral myocarditis: a texture-based analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background. Recent studies revealed the ability of MRI T1 mapping to characterize myocardial involvement in both idiopathic inflammatory myopathy (IIM) and acute viral myocarditis (AVM), as compared to healthy controls. However, neither myocardial T1 nor T2 maps were able to discriminate between IIM and AVM patients, when considering conventional myocardial mean values and derived indices such as lambda and extracellular volume. Purpose. To investigate the ability of T1 mapping-derived texture analysis to differentiate IIM from AVM. Methods. Forty patients, 20 with IIM (51 ± 17 years, 9 men) and 20 with AVM (34 ± 13 years, 16 men) underwent 1.5T MRI T1 mapping using a modified Look-Locker inversion-recovery sequence before and 15 minutes after injection of a gadolinium contrast agent. After manual delineation of endocardial and epicardial borders and co-registration of all inversion time images, native and post-contrast T1 maps were estimated. Myocardial texture analysis was performed on native T1 maps. Textural features such as: autocorrelation, contrast, dissimilarity, energy and sum entropy were used to build a least squares-based linear regression model. Finally, receiver operating characteristic (ROC) analysis was used to investigate the ability of such texture features score to classify IIM vs. AVM patients, compared to the performance of mean myocardial T1. A Wilcoxon rank-sum test was also used to test difference significance between groups. Results. Both native and post-contrast mean myocardial T1 values were comparable between IIM (native: 1022 ± 43 ms; post-contrast: 319 ± 44 ms) and AVM (1056 ± 59 ms, p = 0.07; 318 ± 35 ms, p = 0.90, respectively) groups. Results of ROC analyses are provided in the Table, indicating that a better discrimination between IIM and AVM patients was obtained when using texture features, with higher AUC and accuracy than mean T1 values (Figure). Conclusion. Texture analysis derived from MRI T1 maps without contrast agent injection was able to discriminate between IIM and AVM with higher accuracy, sensitivity and specificity than conventional T1 indices. Such analysis could provide a useful myocardial signature to help diagnose and manage cardiac alterations associated with IIM in patients presenting with myocarditis and primarily suspected of AVM. Table Area under curve (AUC) Accuracy Sensitivity Specificity Native T1 0.67 0.70 0.65 0.75 Post-contrast T1 0.49 0.60 0.25 0.95 Texture features score 0.85 0.82 0.90 0.75 ROC analyses for classification between IIM and AVM patients Abstract Figure

Commentary: May the light guide your way

As the thoracic surgery community encounters increasing numbers of patients who present with smaller (<2 cm) multifocal or ground-glass lesions, interest in segmentectomy continues to grow. Although the oncologic outcomes of segmentectomy versus lobectomy remain a matter of debate,1-3 there has been a renewed focus on the technical aspects of segmentectomy. One such technical challenge is delineation of the intersegmental borders of the target segment. Intersegmental planes have no anatomic landmarks, yet accurate resection margins are critical in ensuring the oncologic quality of the resection.

The Slovenian-Hungarian Border: A Historical Outline

The article presents the facts relating to a century of shifting borders along the frontier between today’s Slovenia and Hungary. As borders primarily symbolize the physical strength of the state, they are an essential subject for people living in borderlands anywhere in the world. Following the Great War, the 1919 delineation of borders in what had for centuries been a stable area (Slovenian March) caused upheaval not only for political actors but also for those persons who suddenly found themselves living in separate states. Later in 1948, the border became part of the Iron Curtain, which completely paralyzed communications in the Yugoslavian (Slovenian)-Hungarian cross-border region and branded it with a highly specific historical and social dynamic. The turn of the 1980s to the 1990s was marked by the fall of the Iron Curtain between the East-European (communist) and Western (capitalist) worlds. After 2004 and 2007, when the Slovenian and Hungarian states became first members of the European Union and then the Schengen area, it seemed that the border would fade away.

Artificial Intelligence Aids Cardiac Image Quality Assessment for Improving Precision in Strain Measurements

ObjectivesThe aim of this study was to develop an artificial intelligence tool to assess echocardiographic image quality objectively. BackgroundLeft ventricular global longitudinal strain (LVGLS) has recently been used to monitor cancer therapeutics−related cardiac dysfunction (CTRCD) but image quality limits its reliability. MethodsA DenseNet-121 convolutional neural network was developed for view identification from an athlete’s echocardiographic dataset. To prove the concept that classification confidence (CC) can serve as a quality marker, values of longitudinal strain derived from feature tracking of cardiac magnetic resonance (CMR) imaging and strain analysis of echocardiography were compared. The CC was then applied to patients with breast cancer free from CTRCD to investigate the effects of image quality on the reliability of strain analysis. ResultsCC of the apical 4-chamber view (A4C) was significantly correlated with the endocardial border delineation index. CC of A4C >900 significantly predicted a <15% relative difference in longitudinal strain between CMR feature tracking and automated echocardiographic analysis. Echocardiographic studies (n =752) of 102 patients with breast cancer without CTRCD were investigated. The strain analysis showed higher parallel forms, inter-rater, and test-retest reliabilities in patients with CC of A4C >900. During sequential comparisons of automated LVGLS in individual patients, those with CC of A4C >900 had a lower false positive detection rate of CTRCD. ConclusionsCC of A4C was associated with the reliability of automated LVGLS and could also potentially be used as a filter to select comparable images from sequential echocardiographic studies in individual patients and reduce the false positive detection rate of CTRCD.

Trabeculated Myocardium in Hypertrophic Cardiomyopathy: Clinical Consequences.

Aims: Hypertrophic cardiomyopathy (HCM) is often accompanied by increased trabeculated myocardium (TM)—which clinical relevance is unknown. We aim to measure the left ventricular (LV) mass and proportion of trabeculation in an HCM population and to analyze its clinical implication. Methods and Results: We evaluated 211 patients with HCM (mean age 47.8 ± 16.3 years, 73.0% males) with cardiac magnetic resonance (CMR) studies. LV trabecular and compacted mass were measured using dedicated software for automatic delineation of borders. Mean compacted myocardium (CM) was 160.0 ± 62.0 g and trabecular myocardium (TM) 55.5 ± 18.7 g. The percentage of trabeculated myocardium (TM%) was 26.7% ± 6.4%. Females had significantly increased TM% compared to males (29.7 ± 7.2 vs. 25.6 ± 5.8, p < 0.0001). Patients with LVEF < 50% had significantly higher values of TM% (30.2% ± 6.0% vs. 26.6% ± 6.4%, p = 0.02). Multivariable analysis showed that female gender and neutral pattern of hypertrophy were directly associated with TM%, while dynamic obstruction, maximal wall thickness and LVEF% were inversely associated with TM%. There was no association between TM% with arterial hypertension, physical activity, or symptoms. Atrial fibrillation and severity of hypertrophy were the only variables associated with cardiovascular death. Multivariable analysis failed to demonstrate any correlation between TM% and arrhythmias. Conclusions: Approximately 25% of myocardium appears non-compacted and can automatically be measured in HCM series. Proportion of non-compacted myocardium is increased in female, non-obstructives, and in those with lower contractility. The amount of trabeculation might help to identify HCM patients prone to systolic heart failure.

Improved Delineation of Cardiac Pathology Using a Novel Three-Dimensional Echocardiographic Tissue Transparency Tool

Accurate visualization of cardiac valves and lesions by three-dimensional (3D) echocardiography is integral for optimal guidance of structural procedures and appropriate selection of closure devices. A new 3D rendering tool known as transillumination (TI), which integrates a virtual light source into the data set, was recently reported to effectively enhance depth perception and orifice definition. We hypothesized that adding the ability to adjust transparency to this tool would result in improved visualization and delineation of anatomy and pathology and improved localization of regurgitant jets compared with TI without transparency and standard 3D rendering. We prospectively studied 30 patients with a spectrum of structural heart disease who underwent 3D transesophageal imaging (EPIQ system, Philips) with standard acquisition and TI with and without the transparency feature. Six experienced cardiologists and sonographers were shown randomized images of all three display types in a blinded fashion. Each image was scored independently by all experts using a Likert scale from 1 to 5, while assessing each of the following aspects: (1) ability to recognize anatomy, (2) ability to identify pathology, including regurgitant jet origin, (3) depth perception, and (4) quality of border delineation. TI images with transparency were successfully obtained in all cases. All experts perceived an incremental value of the transparency mode, compared with TI without transparency and standard 3D rendering, in terms of ability to recognize anatomy (respective scores: 4.5±1.1 vs 4.1±1.1 vs 3.6±1.1, P<.05), ability to identify pathology (4.1±1.1 vs 3.9±1.2 vs 3.3±1, P<.05), depth perception (4.6±0.7 vs 4.1±0.8 vs 3.2±1.0, P<.05), and border delineation (4.6±0.8 vs 4.1±1.0 vs 3.1±1.1, P<.05). The addition of the transparency mode to TI rendering significantly improves the diagnostic and clinical utility of 3D echocardiography and has the potential to markedly enhance echocardiographic guidance of cardiac structural interventions.

Novel contrast agent Visphere™ is feasible for contrast-enhanced ultrasonography in dogs.

Contrast-enhanced ultrasonography provides a more functional diagnostic image than conventional ultrasonography. This prospective exploratory study compared the novel contrast agent, Visphere™ , with commercial contrast agents in five healthy Beagle dogs. Visphere™ has the smallest diameter and highest concentration compared with Sonazoid® and SonoVue® . Each dog received an intravenous injection of Visphere™ , Sonazoid® , or SonoVue® . Images were recorded for 300, 600, and 60 s in the heart, liver, and left kidney, respectively. The mean pixel values of the regions of interest for each organ were expressed as time intensity curves (TIC). The agents all improved the visualization of left ventricular endocardial border delineation in the heart, and had similar TICs and clinical useful durations. In contrast, Visphere™ expressed the highest mean pixel value in the liver parenchyma at an early observation time and maintained the intensity until 600 s, like Sonazoid® . The renal evaluation results indicated there were no statistically significant differences in time-to-peak for the renal cortex or medulla among the agents. Compared with the other two agents, SonoVue® had the lowest peak enhancement for the renal cortex and medulla. No dogs had any adverse reactions during or after the study. All three agents provided adequate results for left ventricular endocardial border delineation, and Visphere™ may have the same potential as Sonazoid® to detect and characterize hepatic lesions. Visphere™ and Sonazoid® may offer better visualization quality to evaluate renal function. In conclusion, the novel contrast agent, Visphere™ , is comparable with commercial agents and could be applied in different major organs in dogs.