Pelvic Imaging Research Articles

O-04 A CASE OF FUNCTIONAL GONADOTROPINOMA PRESENTING WITH OVARIAN MASSES

Abstract Introduction Most gonadotropinomas are nonfunctional macroadenomas, usually diagnosed by immunohistochemical staining. Here, a rare case of functional gonadotropinoma will be presented. Clinical Case A 37-year-old female patient applied to the neurology clinic with a severe headache, and a macroadenoma was detected on cranial magnetic resonance imaging(MRI). She was referred to our endocrinology clinic. Her menstrual cycle was irregular, and she had frequent intermenstrual bleeding for about a year. She has never had galactorrhea, and there were no features of acromegaly or Cushing’s disease on physical examination that would suggest a functional adenoma. The biochemical evaluation showed an elevated estradiol (E2) level of 2900 ng/L (normal 12,5 –166 ng/L) and an elevated prolactin(PRL) level of 203 µg/L (normal 2,8-29,2 µg/L) with normal follicular-stimulating hormone (FSH), luteinizing hormone (LH) and beta-human chorionic gonadotropin (b-hCG) levels of 2,8 IU/L, 6,6 IU/L and 0.1 mIU/mL respectively. PRL level was 196 µg/L after dilution. The low-dose dexamethasone suppression test was 2.1 µg/dL.The patient’s laboratory results are given in Table 1. Pituitary MRI revealed a 31*20*28 mm lesion invading both cavernous sinuses and compressing the optic nerve on the left side(Figure 1A). Visual field testing showed no visual field defects. The patient was consulted with the gynecology and obstetrics clinic due to high estradiol levels. Pelvic MRI revealed 5-6 cystic lesions, the largest of which was 45*30 mm in the right ovary and 41*37 mm in the left ovary, which did not enhance contrast and did not contain solid components (Figure 1B). The patient, who was considered for surgery due to suspicion of malignancy, was planned to be closely followed up by gynecology because tumor markers were negative and the lesions did not enhance contrast. While the patient’s gynecological examinations were continuing, the patient was started on cabergoline one tablet/week. After the gynecology department decided to follow up on the lesions, the patient underwent TSS for macroadenoma. Immunohistochemical staining was positive for FSH and LH, negative for PRL and adrenocorticotropic hormone (ACTH), and the ki-67 index was %2. The patient’s E2, cortisol, and PRL levels became in the normal range after the operation, and her hormone levels are given in Table 1. A pelvic ultrasound performed six months after the operation revealed that the previously detected lesions in the ovaries had disappeared. At this stage, the patient was considered to have functional gonadotropinoma and cortisol elevation has been linked to the effect of estradiol. Conclusion In patients with pituitary macroadenoma, it would be beneficial to check pituitary-gonadal axis hormones even if they are not in the follicular phase to avoid missing functional gonadotropinomas and prevent unnecessary surgeries for ovarian pathologies that may be observed in patients with functional gonadotropinomas.Figure 1:Pituitary and pelvic MRI images of the patientA: Pituitary MRI revealed a 31*20*28 mm lesion invading both cavernous sinuses and compressing the optic nerve on the left side. B: Pelvic MRI revealed 5-6 cystic lesions, the largest of which was 45*30 mm in the right ovary and 41*37 mm in the left ovary, which did not enhance contrast and did not contain solid components. Table 1:Laboratory results of the patientTSS: transsphenoidal surgery, ACTH: Adrenocorticotropic hormone, FSH: follicle stimulating hormone, LH: luteinizing hormone, IGF-1: Insülin-like growth factor, TSH: Thyroid stimulating hormone, fT4: free thyroxie fT3: free triiodothyronine, beta HCG: beta-human chorionic gonadotropin

Evaluation of Perineal Descent Measurements on Pelvic Floor Imaging.

Objectives: The aim of this study is to validate a uniform method for measuring perineal descent which can be used for different imaging methods, to establish cut-off values for this measurement, and to assess diagnostic test accuracy (DTA) of imaging techniques using these cut-off values. Secondly, the study aims to correlate perineal descent to symptoms, signs and imaging findings in women with obstructed defaecation syndrome (ODS) to assess its clinical relevance. Methods: Cross-sectional study of 131 women with symptoms of ODS. Symptoms and signs were assessed using validated methods. These women underwent evacuation proctography (EP), magnetic resonance imaging (MRI), transperineal ultrasound (TPUS) and endovaginal ultrasound (EVUS). Perineal descent was measured on EP and MRI as the position of anorectal junction (ARJ) with respect to the pubococcygeal line (PCL) at rest (i.e., static descent) and during evacuation (i.e., descent at Valsalva). Dynamic perineal descent was measured on all four imaging techniques as the difference between the position of the ARJ at rest and Valsalva. DTA of dynamic perineal descent was estimated using Latent Class Analysis in the absence of a reference standard. Results: Interobserver agreement of dynamic perineal descent measurements was good for MRI and EVUS (ICC 0.86 and 0.85) and moderate for EP and TPUS (ICC 0.61 and 0.59). The systematic differences in measurements between imaging techniques show the need for individual cut-off values. New established cut-off values for dynamic descent are for EP 20 mm, MRI 35 mm, TPUS 15 mm and EVUS 15 mm. Sensitivity was moderate for EP (0.78) and MRI (0.74), fair for TPUS (0.65) and poor for EVUS (0.58). Specificity was similar for all imaging techniques (0.73-0.77). Static perineal descent correlated with symptoms of pelvic organ prolapse (POP) (r = 0.19), prolapse of all three compartments (r = 0.19-0.36), presence of levator ani muscle avulsion (p = 0.01) and increased hiatal area (r = 0.51). Dynamic perineal descent correlated with excessive straining (r = 0.24) and use of laxatives (r = 0.24). Classic symptoms of ODS (incomplete evacuation and digitation) did not correlate with perineal descent measurements. Static and dynamic perineal descent were associated with presence of rectocele, enterocele, intussusception, and absence of anismus. Conclusions: Dynamic perineal descent is a reliable measurement that can be applied to different imaging techniques to allow standardisation. Static descent is more often present in women with POP and dynamic descent is more often present in women with constipation. Perineal descent does not correlate with typical symptoms of ODS. Specificity of TPUS and EVUS is comparable to EP and MRI, hence ultrasound could be used for the initial assessment of pelvic floor dysfunction.

Factors Associated with the Severity of Stress Urinary Incontinence in Elderly Women

Background: Stress urinary incontinence (SUI) is prevalent and significantly impacts morbidity. While some risk factors for SUI have been identified, those specifically related to the severity of SUI have not been thoroughly investigated. Methods: This study recruited elderly female patients with SUI, aged over 60 years old, from Wuhan, Hubei, China, between October and November 2020. Data collection encompassed demographic information, clinical features (including obstetric history, chronic diseases, Urogenital Distress Inventory-6 (UDI-6), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores), as well as physical examinations (including assessments of pelvic floor muscle strength, pelvic organ prolapse quantification (POP-Q) system, and pelvic floor ultrasound imaging). Results: Univariate analysis revealed that a history of postpartum urinary incontinence and chronic constipation significantly influenced the severity of SUI symptoms in the elderly (p < 0.05). Additionally, age, the number of vaginal deliveries, and a history of chronic cough were correlated with the severity of SUI symptoms, with p-values of 0.05, 0.08, and 0.12, respectively. Factors such as pelvic floor muscle strength, vaginal wall prolapse, uterine prolapse, and the morphology of the largest urethral opening all significantly impacted the severity of SUI symptoms in this population (p < 0.05). Multivariate logistic regression analysis identified age, the number of vaginal deliveries, chronic constipation, anterior vaginal wall prolapse, a history of postpartum urinary incontinence, and the shape of the maximum urethral opening as independent factors influencing SUI severity in older women (p < 0.05). The results of the Hosmer-Lemeshow test indicate that the model fits well (p = 0.37). Conclusions: Age, the number of vaginal deliveries, anterior vaginal wall prolapse, a history of postpartum urinary incontinence, chronic constipation, and a funnel-shaped maximum urethral opening are associated with increased severity of SUI symptoms in elderly women. The severity of SUI escalates with advancing age and an increased number of vaginal deliveries.

Ovarian cancer staging and follow-up: updated guidelines from the European Society of Urogenital Radiology female pelvic imaging working group.

To provide up-to-date European Society of Urogenital Radiology (ESUR) guidelines for staging and follow-up of patients with ovarian cancer (OC). Twenty-one experts, members of the female pelvis imaging ESUR subcommittee from 19 institutions, replied to 2 rounds of questionnaires regarding imaging techniques and structured reporting used for pre-treatment evaluation of OC patients. The results of the survey were presented to the other authors during the group's annual meeting. The lexicon was aligned with the Society of American Radiology (SAR)-ESUR lexicon; a first draft was circulated, and then comments and suggestions from the other authors were incorporated. Evaluation of disease extent at diagnosis should be performed by chest, abdominal, and pelvic CT. The radiological report should map the disease with specific mention of sites that may preclude optimal cytoreductive surgery. For suspected recurrence, CT and [18F]FDG PET-CT are both valid options. MRI can be considered in experienced centres, as an alternative to CT, considering the high costs and the need for higher expertise in reporting. CT is the imaging modality of choice for preoperative evaluation and follow-up in OC patients. A structured radiological report, including specific mention of sites that may preclude optimal debulking, is of value for patient management. Question Guidelines were last published for ovarian cancer (OC) imaging in 2010; here, guidance on imaging techniques and reporting, incorporating advances in the field, are provided. Findings Structured reports should map out sites of disease, highlighting sites that limit cytoreduction. For suspected recurrence, CT and 18FDG PET-CT are options, and MRI can be considered. Clinical relevance Imaging evaluation of OC patients at initial diagnosis (mainly based on CT), using a structured report that considers surgical needs is valuable in treatment selection and planning.

Stability of radiomic features in magnetic resonance imaging of the female pelvis: A multicentre phantom study.

Stability of radiomic features in magnetic resonance imaging of the female pelvis: A multicentre phantom study.

Problems of magnetic resonance diagnosis for gastric-type mucin-positive cervical lesions of the uterus and its solutions using artificial intelligence.

To reveal problems of magnetic resonance imaging (MRI) for diagnosing gastric-type mucin-positive (GMPLs) and gastric-type mucin-negative (GMNLs) cervical lesions. We selected 172 patients suspected to have lobular endocervical glandular hyperplasia; their pelvic MR images were categorised into the training (n = 132) and validation (n = 40) groups. The images of the validation group were read twice by three pairs of six readers to reveal the accuracy, area under the curve (AUC), and intraclass correlation coefficient (ICC). The readers evaluated three images (sagittal T2-weighted image [T2WI], axial T2WI, and axial T1-weighted image [T1WI]) in every patient. The pre-trained convolutional neural network (pCNN) was used to differentiate between GMPLs and GMNLs and perform four-fold cross-validation using cases in the training group. The accuracy and AUC were obtained using the MR images in the validation group. For each case, three images (sagittal T2WI and axial T2WI/T1WI) were entered into the CNN. Calculations were performed twice independently. ICC (2,1) between first- and second-time CNN was evaluated, and these results were compared with those of readers. The highest accuracy of readers was 77.50%. The highest ICC (1,1) between a pair of readers was 0.750. All ICC (2,1) values were <0.7, indicating poor agreement; the highest accuracy of CNN was 82.50%. The AUC did not differ significantly between the CNN and readers. The ICC (2,1) of CNN was 0.965. Variation in the inter-reader or intra-reader accuracy in MRI diagnosis limits differentiation between GMPL and GMNL. CNN is nearly as accurate as readers but improves the reproducibility of diagnosis.

Modified Center-Edge Angle in Children with Developmental Dysplasia of the Hip.

Developmental dysplasia of the hip (DDH) is a prevalent developmental condition that necessitates early detection and treatment. Follow-up, as well as therapeutic decision-making in children younger than four years, is challenging because the center-edge (CE) angle of Wiberg is not reliable in this age group. The authors propose a modification of the CE angle (MCE) to achieve comparable reliability with the CE among children younger than four and set diagnostic thresholds for the diagnosis of DDH. 952 anteroposterior pelvic radiographs were retrospectively reviewed. The MCE is defined on X-ray pelvic overview images as the angle between the line connecting the epiphyseal joint center and the outer edge of the acetabulum, and perpendicular to the Hilgenreiner line. The MCE angle exhibited high sensitivity and specificity, as well as intrarater variability comparable to the CE among children younger and older than four years. The authors recommend cut-off values for the MCE angle; for children under four years old, the angle should be equal to or greater than 15 degrees; for those under eight years old, it should be equal to or greater than 20 degrees; and for those eight years old and older, it should be equal to or greater than 25 degrees. However, the MCE angle's reliability diminishes around the age of nine due to the curvature of the growth plate, which complicates accurate measurement. This study showed that the MCE angle can be used adequately in children under four years and could be used as a progression parameter to diagnose DDH.

Intra-Abdominal Desmoplastic Small Round Cell Tumor: A Case Report and Review of Literature

Introduction: Desmoplastic small round cell tumor is an uncommon and aggressive sarcoma affecting young males, its symptomatology is non-specific. Abdominal and pelvic CT scans help to orient, while anatomopathological and cytogenetic studies provide a definitive diagnosis. Case Report: We report a case of a 21 years old male who complains of left hypochondral pain, physical examination revealed a painful mass on left hypochondrium. Abdominal computed tomography revealed intersplenorenal mass and one on left iliac fossa. He underwent a laparoscopic exploration and the resultant biopsy revealed a desmoplastic small round cell tumor. He underwent a neoadjuvant chemotherapy followed by surgery and consolidative radiochemotherapy with no recurrence during the 6 months follow up. Discussion: Desmoplastic small round cell is very rare mesenchymal tumor, it is described as a result from the chromosomal translocation t (11; 22) (p13; q12) by Gerald and Rosai in 1991, it affects usually young male, patients consult for abdominal pain or mass, Computed abdominal and pelvic tomography is the first examination to request, it allows diagnostic orientation and classification, while exploratory laparoscopy and biopsy establish diagnosis with certainty showing Well-defined islands of small, round cells, embedded in abundant desmoplastic stroma with the expression of epidermal markers (cytokeratin, Epithelial Membrane Antigen), mesenchymal markers (desmin, vimentin) and neural markers (neuron specific enolase reactivity). The current treatment is based on neoadjuvant chemotherapy followed by surgery and consolidative radiochemotherapy, but the prognosis is poor. Conclusion: Desmoplastic round cell tumor is an uncommon tumor of the young subject, it must be evoked in the presence of adequate imaging, the multimodal treatment is the current standard, but the prognosis remains poor. Future genetic therapies focused on developing targeted immunotherapy, might promise more optimistic ...

ResNet-Vision Transformer based MRI-endoscopy fusion model for predicting treatment response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: A multicenter study.

Neoadjuvant chemoradiotherapy followed by radical surgery has been a common practice for patients with locally advanced rectal cancer, but the response rate varies among patients. This study aimed to develop a ResNet-Vision Transformer based magnetic resonance imaging (MRI)-endoscopy fusion model to precisely predict treatment response and provide personalized treatment. In this multicenter study, 366 eligible patients who had undergone neoadjuvant chemoradiotherapy followed by radical surgery at eight Chinese tertiary hospitals between January 2017 and June 2024 were recruited, with 2928 pretreatment colonic endoscopic images and 366 pelvic MRI images. An MRI-endoscopy fusion model was constructed based on the ResNet backbone and Transformer network using pretreatment MRI and endoscopic images. Treatment response was defined as good response or non-good response based on the tumor regression grade. The Delong test and the Hanley-McNeil test were utilized to compare prediction performance among different models and different subgroups, respectively. The predictive performance of the MRI-endoscopy fusion model was comprehensively validated in the test sets and was further compared to that of the single-modal MRI model and single-modal endoscopy model. The MRI-endoscopy fusion model demonstrated favorable prediction performance. In the internal validation set, the area under the curve (AUC) and accuracy were 0.852 (95% confidence interval [CI]: 0.744-0.940) and 0.737 (95% CI: 0.712-0.844), respectively. Moreover, the AUC and accuracy reached 0.769 (95% CI: 0.678-0.861) and 0.729 (95% CI: 0.628-0.821), respectively, in the external test set. In addition, the MRI-endoscopy fusion model outperformed the single-modal MRI model (AUC: 0.692 [95% CI: 0.609-0.783], accuracy: 0.659 [95% CI: 0.565-0.775]) and the single-modal endoscopy model (AUC: 0.720 [95% CI: 0.617-0.823], accuracy: 0.713 [95% CI: 0.612-0.809]) in the external test set. The MRI-endoscopy fusion model based on ResNet-Vision Transformer achieved favorable performance in predicting treatment response to neoadjuvant chemoradiotherapy and holds tremendous potential for enabling personalized treatment regimens for locally advanced rectal cancer patients.

Cone Beam Computed Tomography Image-Quality Improvement Using "One-Shot" Super-resolution.

Cone beam computed tomography (CBCT) images are convenient representations for obtaining information about patients' internal organs, but their lower image quality than those of treatment planning CT images constitutes an important shortcoming. Several proposed CBCT image-quality improvement methods based on deep learning require large amounts of training data. Our newly developed model using a super-resolution method, "one-shot" super-resolution (OSSR) based on the "zero-shot" super-resolution method, requires only small amounts of training data to improve CBCT image quality using only the target CBCT image and the paired treatment planning CT image. For this study, pelvic CBCT images and treatment planning CT images of 30 prostate cancer patients were used. We calculated the root mean squared error (RMSE), peak signal-to-noise ratio (PSNR), and structural similarity (SSIM) to evaluate image-quality improvement and normalized mutual information (NMI) as a quantitative evaluation of positional accuracy. Our proposed method can improve CBCT image quality without requiring large amounts of training data. After applying our proposed method, the resulting RMSE, PSNR, SSIM, and NMI between the CBCT images and the treatment planning CT images were as much as 0.86, 1.05, 1.03, and 1.31 times better than those obtained without using our proposed method. By comparison, CycleGAN exhibited values of 0.91, 1.03, 1.02, and 1.16. The proposed method achieved performance equivalent to that of CycleGAN, which requires images from approximately 30 patients for training. Findings demonstrated improvement of CBCT image quality using only the target CBCT images and the paired treatment planning CT images.

Optimization of Radiation Dose and Effective Dose for CT Pelvis Examinations in Main Hospitals in ALTaif Region

Introduction: CT scan is one of the medical imaging methods that irradiate patients with significant amounts of radiation. These amount of radiation doses must be well estimated if the imaging area is in part containing radiation-sensitive organs such as the pelvic area. Objectives: the objectives of the current study were to assess radiation dose during pelvis and Abdomen CT imaging and estimate the effective dose as well as to propose diagnostic reference level (DRL).Methodology: 200 adult patients irradiated in two major governmental hospital in Taif city, Saudi Arabia, patients’ demographic data from was collected such as weight, height, and age. Scanner specifications and scan parameters for each pelvis examination were recorded in special data collection sheet. Volume CT dose index (CTDIvol and dose length product (DLP) were utilized to estimate the radiation dose and effective dose. Microsoft Excel was used to analyse the data.Main Results: there was variation in scanning parameters among two hospitals under study and this result in variation in effective dose between two hospitals. The average DLP, CTDIvol and effective dose were 368.5, 390.7 mGy-cm,10.2,10.8 mGy and 7, 7.4 mSv for hospital one and two respectively. Conclusion: Based on the third quartile of DLP and CTDIw, the recommended DRL for both hospitals was 405 mGy-cm and 21.75 mGy, respectively. The findings revealed a reduced effective dose value when compared with previous studies.

Do some levator avulsions improve over time?

To determine whether the sonographic appearance of levator avulsion after vaginal childbirth can improve significantly over the first few years postpartum. Retrospective study of women seen in the context of two prospective perinatal imaging studies. All subjects had undergone an interview, clinical examination and 4D translabial ultrasound (TLUS) on average 4.3 months and 3.1 years post-partum. Volume data sets were analysed at a later date blinded against all other data. The number of abnormal slices at both time points was compared using Mann- Whitney U Test. Patients in whom findings had changed over time were reviewed separately in parallel in order to reduce the impact of differences in slice location and imaging settings. The symmetry test was used to analyse changes between the two postnatal visits. Of 1148 women originally recruited, 315 had had at least two postnatal visits. 42 were excluded, leaving 273 women for analysis.They were first seen on average 4.3 (2.6-9.8) months after childbirth and the last time 3.1 (1.4-8) years postpartum. Cohen's kappa for the two assessments was 0.89, with agreement in 97% (264/273) of cases. At the first visit, complete avulsion was diagnosed in 20, partial avulsion in 32, and no avulsion in 221. While seven partial avulsions appeared sonographically normal at the second visit, there were no statistically significant changes in avulsion category between visits (P=0.4). Tomographic pelvic floor imaging obtained 2.5-10 months after childbirth may be used as a proxy for long- term outcomes. Findings at a mean of 3.1 years showed 97% agreement with imaging obtained at an average of 4.3 months. There was a non-significant reduction in abnormal slices affecting at most 3/12 slices. This may be explained by compensatory hypertrophy of remaining intact muscle. Sonographic normalisation of complete avulsion was not observed. This article is protected by copyright. All rights reserved.

Updates to Male Infertility: AUA/ASRM Guideline (2024).

In 2023 the American Urological Association (AUA) requested an Update Literature Review (ULR) to incorporate new evidence generated since the 2020 publication of this Guideline. The resulting 2024 Guideline Amendment addresses updated recommendations to provide guidance on the appropriate evaluation and management of the male partner in an infertile couple. In 2023, the Male Infertility Guideline was updated through the AUA amendment process in which newly published literature is reviewed and integrated into previously published guidelines. An updated literature search identified 4093 new abstracts. Following initial abstract screening, 125 eligible study abstracts met inclusion criteria. On data extraction, 22 studies of interest were included in the final evidence base to inform the Guideline amendment. The Panel developed evidence- and consensus-based statements based on an updated review to provide guidance on evaluation and management of male infertility. These updates are detailed herein. This update provides several new insights, including revised thresholds for Y-chromosome microdeletion testing, indications for pelvic magnetic resonance imaging (MRI) imaging in infertile males, and guidance regarding the use of testicular sperm in nonazoospermic males. This Guideline will require further review as the diagnostic and treatment options in this space continue to evolve.

Assessing the value of computed tomography (CT) of the chest in the follow-up of patients with intrahepatic cholangiocarcinoma.

Following tumor resection, imaging recommendation for the follow-up of patients with intrahepatic cholangiocarcinoma (IHCCA) include frequent chest, abdomen and pelvis computed tomography (CT) imaging. The appropriateness of additional imaging studies is usually derived from their clinical utility. The purpose of this work is to determine the value of chest CT imaging in the follow-up of patients with IHCCA. Data review of radiology reports of baseline post-operative chest, abdominal, and pelvic CT imaging reports following the resection of IHCCA, and of subsequent follow-up exams. The radiology findings were stratified as intrathoracic metastasis only, combined intra-thoracic and intraabdominal metastasis, intra-abdominal metastases without intrathoracic involvement. We assessed the prevalence of intra-thoracic disease progression in comparison to other groups. Descriptive statistical analysis was carried out using John's Macintosh Project (JMP) statistical software. Eighty-seven patients were included in the study, 6 patients were found to have disease progression in the chest without corresponding disease progression in the abdomen on follow-up CT, accounting for 6.9% of the total. Only four patients had disease progression in the chest with a normal CT chest at baseline (4.6%). The use of short-interval chest CT for surveillance in IHCCA has limited utility, particularly in patients with disease-free abdominal studies.

Impact of uterine displacement on T2-weighted image quality in the female pelvic MRI.

Despite the importance of T2-weighted image in clinical practice, artifacts can significantly degrade image quality and affect diagnosis. This study quantitatively analyzed uterine displacement and surveyed the relationship between the image quality of fast-spin-echo-T2-weighted image of the female pelvis and quantitative value of uterine displacement. Overall, 147 women (mean age, 46.0 ± 12.8years; age range, 22-84years) who had undergone pelvic magnetic resonance imaging examination using a 3T- magnetic resonance imaging scanner were included. Two radiologists performed a visual assessment of the fast-spin-echo-T2-weighted image in the sagittal plane in terms of ghosts and motion blur, and classified the image quality into the following three groups: poor, moderate, and excellent. Uterine displacement on half-Fourier acquisition single-shot turbo spin-echo-cine images was calculated, and the maximum amplitude of uterine displacement and summation of uterine displacement were calculated from the displacement map images. The Kruskal-Wallis and Steel-Dwass tests were performed to compare the maximum amplitude of uterine displacement and summation of uterine displacement among the three groups. Poor, moderate, and excellent image qualities were observed in 48, 71, and 28 patients, respectively. The quality of fast-spin-echo-T2-weighted images degraded statistically significantly with P < 0.01 as the maximum amplitude of uterine displacement increased. The summation of uterine displacement in the poor and moderate groups had greater statistical significance with P < 0.01 than that in the excellent group.

Artificial intelligence in abdominal and pelvic ultrasound imaging: current applications.

In recent years, the integration of artificial intelligence (AI) techniques into medical imaging has shown great potential to transform the diagnostic process. This review aims to provide a comprehensive overview of current state-of-the-art applications for AI in abdominal and pelvic ultrasound imaging. We searched the PubMed, FDA, and ClinicalTrials.gov databases for applications of AI in abdominal and pelvic ultrasound imaging. A total of 128 titles were identified from the database search and were eligible for screening. After screening, 57 manuscripts were included in the final review. The main anatomical applications included multi-organ detection (n = 16, 28%), gynecology (n = 15, 26%), hepatobiliary system (n = 13, 23%), and musculoskeletal (n = 8, 14%). The main methodological applications included deep learning (n = 37, 65%), machine learning (n = 13, 23%), natural language processing (n = 5, 9%), and robots (n = 2, 4%). The majority of the studies were single-center (n = 43, 75%) and retrospective (n = 56, 98%). We identified 17 FDA approved AI ultrasound devices, with only a few being specifically used for abdominal/pelvic imaging (infertility monitoring and follicle development). The application of AI in abdominal/pelvic ultrasound shows promising early results for disease diagnosis, monitoring, and report refinement. However, the risk of bias remains high because very few of these applications have been prospectively validated (in multi-center studies) or have received FDA clearance.

Acute avulsion fracture of the ischial tuberosity in an adolescent athlete treated by suture anchor fixation using the suture bridge technique: a case report

Abstract This is the first report of acute avulsion fracture of the ischial tuberosity (AFIT) treated by suture anchor fixation using the suture bridge technique. A 13-year-old boy developed sudden, severe right hip pain while running a short distance. Pelvic images revealed the avulsion fracture of the right ischial tuberosity with displacement of the avulsed fragment by 35 mm. We performed open reduction and reconstruction fixation 5 days after the injury using the subgluteal approach with longitudinal skin incision. Four suture anchors were set at the ischial tuberosity, and the avulsed fragment was repositioned and fixed using the suture bridge technique. At 1 year postoperatively, the avulsion fracture was bony fused, and he had returned to his preinjury competitive level. Use of multiple suture anchors increases the strength of fixation, which overcomes the problem of anchor loosening and makes open reduction and reconstruction fixation an effective treatment for acute avulsion fracture of the ischial tuberosity.

Impact of Residual Stone Fragments on Risk of Unplanned Stone Events Following Percutaneous Nephrolithotomy.

Purpose: Residual stone fragments are common after percutaneous nephrolithotomy (PCNL), however, there is an unclear relationship between the presence of these residual stone fragments and the risk of unplanned stone events (USE). We investigated how the size of the largest residual stone fragment (LRSF) impacts the risk of USE post-PCNL. Materials and Methods: We conducted a retrospective cohort study of PCNL between 2018 and 2022. Preoperative computed tomography of the abdomen and pelvis (CTAP) imaging and postoperative CTAP imaging were reviewed. The primary outcome was the incidence of postoperative USE, defined as stone-related emergency department visits or unplanned stone procedures. LRSF were stratified by five thresholds (no postoperative stone fragments vs ≥0 mm, <2 vs ≥2 mm, <3 vs ≥3 mm, <4 vs ≥4 mm, and <5 vs ≥5 mm), and Cox regression was used to compare the impact of these thresholds on the risk of USE. Results: After exclusions, we identified 138 patients who underwent PCNL during the study period; 42 patients had a USE. When applying a 4 mm threshold, 52% of patients with LRSF ≥4 mm experienced USE vs 21% with LRSF <4 mm (log-rank p = 0.0004); similarly, with a 5 mm threshold, 62.5% with LRSF ≥5 mm had such events compared with 21% with LRSF <5 mm (log-rank p < 0.00001). A larger LRSF was associated with a greater risk of having a USE. Conclusion: After PCNL, larger residual stone fragments, particularly those ≥4 mm, are associated with an increased risk of USE. These results demonstrate the value of identifying residual fragments in predicting USE.

An optimized siamese neural network with deep linear graph attention model for gynaecological abdominal pelvic masses classification.

An adnexal mass, also known as a pelvic mass, is a growth that develops in or near the uterus, ovaries, fallopian tubes, and supporting tissues. For women suspected of having ovarian cancer, timely and accurate detection of a malignant pelvic mass is crucial for effective triage, referral, and follow-up therapy. While various deep learning techniques have been proposed for identifying pelvic masses, current methods are often not accurate enough and can be computationally intensive. To address these issues, this manuscript introduces an optimized Siamese circle-inspired neural network with deep linear graph attention (SCINN-DLGN) model designed for pelvic mass classification. The SCINN-DLGN model is intended to classify pelvic masses into three categories: benign, malignant, and healthy. Initially, real-time MRI pelvic mass images undergo pre-processing using semantic-aware structure-preserving median morpho-filtering to enhance image quality. Following this, the region of interest (ROI) within the pelvic mass images is segmented using an EfficientNet-based U-Net framework, which reduces noise and improves the accuracy of segmentation. The segmented images are then analysed using the SCINN-DLGN model, which extracts geometric features from the ROI. These features are classified into benign, malignant, or healthy categories using a deep clustering algorithm integrated into the linear graph attention model. The proposed system is implemented on a Python platform, and its performance is evaluated using real-time MRI pelvic mass datasets. The SCINN-DLGN model achieves an impressive 99.9% accuracy and 99.8% recall, demonstrating superior efficiency compared to existing methods and highlighting its potential for further advancement in the field.

Long-Term Orthopaedic and Radiological Outcomes of Symphysis Approximation without Osteotomy in Primary Bladder Exstrophy Repair.

Previous assumptions suggested that the technique of approximation without osteotomy in primary exstrophy repair (PER) could only be applied in newborns and anticipated poorer outcomes. Recent studies indicated that this technique can be successfully executed not only in immediate PER but also yields favorable long-term results. Therefore, we evaluated and compared the orthopaedic and radiological long-term outcomes after pubic symphysis approximation without osteotomy in immediate and delayed PER. From March 2018 to December 2020, individuals with PER and approximation of the symphysis without osteotomy were recruited. Patients <12 years and with a history of orthopaedic surgery of the bony pelvis were excluded. Orthopaedic examinations and magnetic resonance imaging (MRI) of the bony pelvis including the hip joints were performed and pubic diastasis, the acetabulum angle (ACA), and the center-edge angle (CEA) were evaluated. Twenty-nine patients were included, 11 of them had an immediate and 18 had a delayed PER. Between the two groups, no significant differences could be observed concerning hip pain (p = 0.419), mobility impairment (p = 0.543), sports impairment (p = 0.543), hip impingement (p = 1.000), leg length discrepancy (p = 0.505), and width of the pubic diastasis as measured by MRI (p = 0.401). There were also no significant differences with regard to CEA right (median 30 degrees, p = 0.976), CEA left (median 31.5 degrees, p = 0.420), ACA right (median 19 degrees, p = 0.382), and ACA left (median 17 degrees, p = 0.880). There were no significant differences in clinical orthopaedic or radiological long-term outcomes between bladder exstrophy patients after immediate and delayed bladder closure with symphysis approximation without osteotomy. Establishing core outcome sets is essential to get robust and comparable results, further advancing and substantiating our initial insights.