Chest Computer Research Articles

Deep Learning-Based Natural Language Processing in Radiology: The Impact of Report Complexity, Disease Prevalence, Dataset Size, and Algorithm Type on Model Performance

In radiology, natural language processing (NLP) allows the extraction of valuable information from radiology reports. It can be used for various downstream tasks such as quality improvement, epidemiological research, and monitoring guideline adherence. Class imbalance, variation in dataset size, variation in report complexity, and algorithm type all influence NLP performance but have not yet been systematically and interrelatedly evaluated. In this study, we investigate these factors on the performance of four types [a fully connected neural network (Dense), a long short-term memory recurrent neural network (LSTM), a convolutional neural network (CNN), and a Bidirectional Encoder Representations from Transformers (BERT)] of deep learning-based NLP. Two datasets consisting of radiologist-annotated reports of both trauma radiographs (n = 2469) and chest radiographs and computer tomography (CT) studies (n = 2255) were split into training sets (80%) and testing sets (20%). The training data was used as a source to train all four model types in 84 experiments (Fracture-data) and 45 experiments (Chest-data) with variation in size and prevalence. The performance was evaluated on sensitivity, specificity, positive predictive value, negative predictive value, area under the curve, and F score. After the NLP of radiology reports, all four model-architectures demonstrated high performance with metrics up to > 0.90. CNN, LSTM, and Dense were outperformed by the BERT algorithm because of its stable results despite variation in training size and prevalence. Awareness of variation in prevalence is warranted because it impacts sensitivity and specificity in opposite directions.

Molecular markers of aging, exercise capacity, & physical activity in COPD

BackgroundExercise capacity (EC) and physical activity (PA) are independent, potentially modifiable predictors of clinical outcomes in COPD. Molecular measures of biological age may help characterize variability in EC and PA observed among COPD patients. MethodsVeterans with COPD (FEV1/FVC<0.7 or emphysema on chest computed tomography) enrolled in 2 cohorts at VA Boston completed questionnaires, a 6-min walk distance (6MWD) for EC, and blood collection at enrollment. PA data (average daily step count) was collected using an HJ-720 ITC pedometer over ≥5 days. A subset of subjects returned for repeat assessment after 12 weeks. DNA methylation data was generated using the HumanMethylationEPIC platform; epigenetic estimates of biological age and age acceleration were generated using established algorithms. Multivariable models examined the associations between biological age, 6MWD, PA and future acute exacerbations (AEs), adjusting for chronological age, sex, race, smoking status, pack-years, body mass index, cohort, and estimated cell counts. ResultsSubjects (n = 269) were predominantly male (98.5%), white (92.9%), and elderly (70.6 ± 8.5 years) with average FEV1% of 57.7 ± 21.1, 6MWD of 374.3 ± 93.5 m, and daily steps of 3043.4 ± 2374 at baseline. In adjusted models, multiple measures of baseline epigenetic age and age acceleration were inversely associated with 6MWD; only GrimAge was inversely associated with PA. Longitudinal change in Hannum-Age was inversely associated with change in EC at 12 weeks (n = 94). No measures of biological age were significantly associated with prospective AEs over 1.3 ± 0.3 years. ConclusionsEpigenetic measures of biological age are independent predictors of EC and PA, but not AEs, among individuals with COPD.

Portal hypertension as an uncommon presentation of hepatic epithelioid hemangioendothelioma: a case report

Hepatic epithelioid hemangioendothelioma (HEHE) is a vascular tumor with a low incidence rate. We report a case of a 26-year-old man who was referred to our hospital with a misdiagnosis of liver cirrhosis. On physical examination, ascites was noted. Chest and abdominal computer tomography scans showed coalescent lesions involving the peripheral liver with heterogeneous contrast enhancement and portal vein dilation due to portal hypertension. Extrahepatic metastasis was not observed. The biopsy with immunohistochemical stains suggested HE d CD34). This report describes an uncommon case of HEHE with non-cirrhotic portal hypertension.

INTRAORAL MELANOMA OF THE INTERPROXIMAL PAPILLA: A RARE PRESENTATION

A 37-year-old woman, with no history of diseases or medical treatment, presented with an asymptomatic nonulcerated lesion, at the lower posterior gingiva. The patient had periodontitis with periodical control and the intraoral exam showed a single, hardened nodule measuring 1 × 0.5 cm, with a smooth surface and sessile base, surrounding the interproximal distal space between the first and second left lower molars. Radiographically, there was no evidence of bone compromise. Pigmentation was only seen on the lingual area. An incisional biopsy was made, providing the diagnosis of melanoma with immunohistochemical positive reaction for HMB-45 and S-100. Chest radiograph and computer tomography (CT) scan of the cervical area was required to rule out any metastatic lesion; the results were negative. The patient underwent a mandibular and neck surgery showing 1 positive lymph node out of 37 sentinel lymph nodes. She received oncologic treatment with no recurrence after 3 years.

Cushing’s syndrom (АCTH-ectopic tumor): сase from practice

The article describes the clinical case of ectopic Cushing’s syndrome in 29 years old male. The clinical signs of adrenal syndrome (obesity, red strias, myasthenia) were present. During the laboratory examination: ACTH — 12,7 pg/ml (normal:8,3–57,8); the big dexamethasone test was conducted: cortisol before loading — 508,46 ng/ml, cortisol after loading — 392,37 ng/ml (normal 50–250). The topic diagnostics of the source of hypercortitsizm was conducted: ultrasonography of adrenal glands, radiography of the head, magnetic resonance tomography of adrenal glands and pituitary with contrast. The diagnosis was made thanks to examination: Cushing’s disease. The treatment was prescribed (mitotanum, bromcreptinum), however it was not successful: the clinical symptoms persisted and the laboratory indicators did not come back to normal. Since there were no positive dynamic, the levels of ACTH and cortisol were high and clinical symptoms remained, we assumed АCTH-ectopic tumor. The chest and abdominal multi-circle computer tomography with contrast was made for the patient and the bronchogenic carcinoid was identified. The diagnosis was specified: Cushing’s syndrome, ACTH-ectopic tumor (bronchogenic carcinoid). Patient was operated successfully and histological examination confirmed the correct diagnosis. All clinical symptoms regressed after surgical treatment. The peculiarity of this clinical case is that the final diagnosis was made only in one year after appearance of clinical signs which was due to the difficulty of diagnosing various form of Cushing’s syndrome. Magnetic resonance tomography of adrenal glands and pituitary, abdominal ultrasonography, laboratory diagnostic methods didn’t allow to make the correct diagnosis. Only the use of multi-circle computed tomography with contrast has allowed to make the correct diagnosis and conduct effective treatment for the patient

AB0509 Gastrointestinal involvement in systemic sclerosis patients

BackgroundGastrointestinal involvement in systemic sclerosis (SS) is frequent (70-90% of the patients), different (it affected the whole digestive system) and persistent, contributing to the alteration of quality of life in...

Five-year follow-up of patients treated for 1 year with octreotide long-acting release for enterochromaffin-like cell carcinoids

Background. Gastric carcinoids type 1 (GC1) are neuroendocrine tumors (NETs) arising from the enterochromaffin-like (ECL) cells in patients with chronic atrophic gastritis (CAG). The treatment of GC1 has been endoscopic polypectomy or surgical tumor excision and antrectomy. One year treatment with somatostatin analogs (SSAs) diminished tumor load and ECL cell density. The effect persisted 1 year after treatment was discontinued. However, the optimal SSA dose and treatment duration are unknown. Objectives. The aim of the present work was to study macroscopic and histopathological changes in the stomach and serum markers gastrin and chromogranin A (CgA) in GC1 patients 5 years after 1 year of octreotide long-acting release (LAR) treatment. Material and methods. Five patients with GC1 were included 5 years after the initial year of octreotide LAR treatment. All patients underwent upper gastrointestinal endoscopy including tumor and mucosal biopsies from oxyntic mucosa, chest and abdominal computer tomography and octreotide scintigraphy. Fasting serum gastrin and CgA were also measured. Results. At 5 years, one patient had a highly malignant gastric tumor, one patient had an increased number of GCs, regional and distant metastases and three patients had an increased number of GCs. Serum gastrin and CgA increased to pre-treatment levels after 1 year of follow-up and were unchanged at the 5-year follow-up. Conclusions. The disease had progressed in all five GCs patients treated with octreotide for 12 months at 5 years of follow-up. This suggests that, if started, octreotide treatment should not be discontinued in these patients.

Bullous pemphigoid as a dermadrome associated with spindle cell carcinoma of the gallbladder

Skin disorders that appear in association with internal malignancies are called dermadromes. Bullous pemphigoid (BP), which is a major autoimmune disease of the skin, is considered to be a dermadrome, although there have been conflicting reports. We report a case of BP that preceded the diagnosis of an internal malignancy. Although we could not detect any malignancies on chest, abdominal or pelvic computer tomography on the first hospital admission, intensive screening on the third admission revealed a gallbladder malignancy. Laparoscopic cholecystectomy was performed. Histopathology showed a spindle cell carcinoma of the gallbladder. To the best of our knowledge, this is the first report of a spindle cell carcinoma of the gallbladder in a patient with BP.

Multifocal Nodular Lymphoid Hyperplasia of the Lung Differently Identified by18F-Fluorodeoxyglucose Positron Emission Tomography (FDG‐PET)

Nodular lymphoid hyperplasia (NLH) is a rare lung disease classified as a non-neoplastic pulmonary lymphoid lesion. It is believed that 36 % of cases present with multifocal lesions, and although there are some reports in which (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) results are positive, the FDG uptakes vary and the imaging findings are very similar to those of lung cancer or malignant lymphoma. We present a case of surgically resected multifocal NLH which was differently identified by chest computed (CT) tomography appearance and FDG-PET findings.

33-jährige Libanesin mit rezidivierenden Hämoptysen und zystischer Raumforderung in der Lunge

A 33 year old woman from Lebanon presented with recurrent hemoptysis, subfebrile temperature, dyspnoe in stress, fatigue, weight loss, and pruritus. Serological tests and results from chest X-ray and computer tomography revealed cystic echinococcosis with pulmonary involvement. After refusal of surgical therapy a medical treatment with albendazole was implemented. Two months after the start of the therapy only a small fibrotic residuum in the lung was seen. A spontaneous healing success seems unlikely because of the duration of the pulmonary cyst and the progressive symptoms before treatment.

Adult Onset of a Thalassemia Intermedia Genotype in Association with a − α− 3.7 Homozygosity. Hb G-Accra [β73(E17)Asp→Asn] in Combination with β- and α-Thalassemia in the Same Family

We present the case of a 39-year-old male of mixed Black and Chinese Surinamese origin referred because of abdominal pain and extreme tiredness. The patient reported that he had received a single blood transfusion in his youth and presented at intake with a severe microcytic hypochromic anemia. A chest X-ray and computer tomography (CT)-scan revealed bilateral mediastinal lymphadenopathy and interstitial infiltrates. Elevated Hb F (80%) and an unbalanced syntheis ratio (β/α = 0.18) were compatible with severe β-thalassemia (thal) intermedia. DNA analysis revealed a double heterozygoty for the − 88 (C→T) and the IVS-II-654 (C→T) mutations in the presence of a homozygosity for the − α3.7 deletion. The two daughters of the proband were both heterozygous for the IVS-II-654 (C→T) mutation and the − α3.7 deletion. The youngest daughter also carried the Hb G-Accra [β73(E17)Asp→Asn] mutation, inherited from the mother. Hb G-Accra, a mutant of presumed Ghanaian origin, described as non pathological in the carrier, is reported for the first time in combination with a severe β+-thal. The molecular background, haplotype of the mutations and a new A→G polymorphism at − 309, 5′ to the Gγ promoter, are reported.