Radiographic Patterns Research Articles

The Segmentation of Neutron Digital Radiography Image through the Edge Detection Method

The digital image processing is one way to manipulate one or more digital images. Image segmentation has an essential role in the field of image analysis. The aim of this study was to develop an application to perform digital image processing of neutron digital radiographic images, hoping to improve the image quality of the digital images produced. The quality of edge detection could be used for the introduction of neutron digital radiographic image patterns through artificial intelligence. Interaction of neutrons with the matter mainly by nuclear reaction, elastic, and inelastic scattering. A neutron can quickly enter into a nucleus of an atom and cause a reaction. It is because a neutron has no charge. Neutrons can be used for digital imaging due to high-resolution information from deep layers of the material. The attenuated neutron beam in neutron radiography are passing through the investigated object. The object in a uniform neutron beam is irradiated to obtain an image neutron. The technique used in segmenting the neutron radiography in this study was a digital technique using a camera with a charge-coupled device (CCD), which was deemed more efficient technique compared to the conventional one. Through this technique, images could be displayed directly on the monitor without going through the film washing process. Edge detection methods were implemented in the algorithm program. It was the first step to complement the image information where edges characterize object boundaries. It is useful for the process of segmenting and identifying objects in neutron digital radiography images. The edge detection methods used in this study were Sobel, Prewitt, Canny, and Laplacian of Gaussian. According to the results of the image that have been tested for edge detection, the best image was carried out by the Canny operator because the method is more explicit. The obtained edges were more connected than the other methods which are still broken. The Canny technique provided edge gradient orientation which resulted in a proper localization.

Multi-View Ensemble Convolutional Neural Network to Improve Classification of Pneumonia in Low Contrast Chest X-Ray Images.

Pneumonia is one of the leading causes of childhood mortality worldwide. Chest x-ray (CXR) can aid the diagnosis of pneumonia, but in the case of low contrast images, it is important to include computational tools to aid specialists. Deep learning is an alternative because it can identify patterns automatically, even in low-resolution images. We propose herein a convolutional neural network (CNN) architecture with different training strategies towards detecting pneumonia on CXRs and distinguishing its subforms of bacteria and virus. We also evaluated different image pre-processing methods to improve the classification. This study used CXRs from pediatric patients from a public pneumonia CXR dataset. The pre-processing methods evaluated were image cropping and histogram equalization. To classify the images, we adopted the VGG16 CNN and replaced its fully-connected layers with a customized multilayer perceptron. With this architecture, we proposed and evaluated four different training strategies: original CXR image (baseline), chest-cavity-cropped image (A), and histogram-equalized segmented image (B). The last strategy method (C) implemented is based on ensemble between strategies A and B. The performance was assessed by the area under the ROC curve (AUC) with 95% confidence interval (CI), accuracy, sensitivity, specificity, and F1-score. The ensemble model C yielded the highest performances: AUC of 0.97 (CI: 0.96-0.99) to classify pneumonia vs. normal, and AUC of 0.91 (CI: 0.88-0.94) to classify bacterial vs. viral cases. All models that used pre-processed images showed higher AUC than baseline, which used the original CXR image. Image cropping and histogram equalization reduced irrelevant information from the exam, enhanced contrast, and was able to identify fine CXR texture details. The proposed ensemble model increased the representation of inflammatory patterns from bacteria and viruses with few epochs to train the deep CNNs.Clinical relevance- Deep learning can identify complex radiographic patterns in low contrast images due to pneumonia and distinguish its subforms of bacteria and virus. The correlation of imaging with lab results could accelerate the adoption of complementary exams to confirm the disease's cause.

Defining Treatment-Related Adverse Effects in Patients with Glioma: Distinctive Features of Pseudoprogression and Treatment-Induced Necrosis.

BackgroundPseudoprogression (PP) and treatment‐induced brain tissue necrosis (TN) are challenging cancer treatment–related effects. Both phenomena remain insufficiently defined; differentiation from recurrent disease frequently necessitates tissue biopsy. We here characterize distinctive features of PP and TN to facilitate noninvasive diagnosis and clinical management.Materials and MethodsPatients with glioma and confirmed PP (defined as appearance <5 months after radiotherapy [RT] completion) or TN (>5 months after RT) were retrospectively compared using clinical, radiographic, and histopathological data. Each imaging event/lesion (region of interest [ROI]) diagnosed as PP or TN was longitudinally evaluated by serial imaging.ResultsWe identified 64 cases of mostly (80%) biopsy‐confirmed PP (n = 27) and TN (n = 37), comprising 137 ROIs in total. Median time of onset for PP and TN was 1 and 11 months after RT, respectively. Clinically, PP occurred more frequently during active antineoplastic treatment, necessitated more steroid‐based interventions, and was associated with glioblastoma (81 vs. 40%), fewer IDH1 mutations, and shorter median overall survival. Radiographically, TN lesions often initially manifested periventricularly (n = 22/37; 60%), were more numerous (median, 2 vs. 1 ROIs), and contained fewer malignant elements upon biopsy. By contrast, PP predominantly developed around the tumor resection cavity as a non‐nodular, ring‐like enhancing structure. Both PP and TN lesions almost exclusively developed in the main prior radiation field. Presence of either condition appeared to be associated with above‐average overall survival.ConclusionPP and TN occur in clinically distinct patient populations and exhibit differences in spatial radiographic pattern. Increased familiarity with both conditions and their unique features will improve patient management and may avoid unnecessary surgical procedures.Implications for PracticePseudoprogression (PP) and treatment‐induced brain tissue necrosis (TN) are challenging treatment‐related effects mimicking tumor progression in patients with brain cancer. Affected patients frequently require surgery to guide management. PP and TN remain arbitrarily defined and insufficiently characterized. Lack of clear diagnostic criteria compromises treatment and may adversely affect outcome interpretation in clinical trials. The present findings in a cohort of patients with glioma with PP/TN suggest that both phenomena exhibit unique clinical and imaging characteristics, manifest in different patient populations, and should be classified as distinct clinical conditions. Increased familiarity with PP and TN key features may guide clinicians toward timely noninvasive diagnosis, circumvent potentially unnecessary surgical procedures, and improve response assessment in neuro‐oncology.

4541 Harnessing the Power of the Electronic Medical Record in Interstitial Lung Disease

OBJECTIVES/GOALS: Harnessing the EHR to support clinical research is critical for the study of rare diseases such as interstitial lung disease (ILD). However no studies have compared EHR and research-quality data in the ILD population. Our objectives were to (1) identify ILD patients and extract clinical data from an EHR system and (2) assess the performance of ILD data capture. METHODS/STUDY POPULATION: Case validated algorithms were implemented to identify patients from the University of California San Francisco EHR and extract key ILD clinical information including, demographic variables, process measures and patient outcomes. Key clinical information were defined based on consensus statements and ILD clinical trials. A subset of ILD patients, had variables recorded in both the EHR and a separate ILD longitudinal research database. The completeness of EHR data capture and level of agreement were compared between three data collection methods: (1) data manually and systematically collected for an ILD research database (gold standard), (2) data automatically extracted from structured fields in the EHR, and (3) data extracted from unstructured data sources. RESULTS/ANTICIPATED RESULTS: We identified 5857 ILD patients in the EHR, of which 2100 patients had data available in the both the EHR and research database. Baseline demographic variables, co-morbidities, use of diagnostic testing, pharmacotherapy were accurately extracted from structured fields. Outcome measures, including lung physiology, radiographic patterns, pathology results, and health related quality of life (HRQoL) were unevenly extracted from structured fields alone. With the exception of HRQoL, these measures were accurately captured in unstructured EHR sources. Notably, certain metrics were better defined in the EHR, including health care resource utilization metrics, acute exacerbations, medication side effects, supplemental oxygen use and specialty care referrals (rheumatology, lung transplant, palliative care, etc). DISCUSSION/SIGNIFICANCE OF IMPACT: A large real-world ILD cohort can be algorithmically extracted from the EHR along with key clinical variables with accuracy comparable to protocol-driven research databases. Rigorous assessment of the types of disease-specific variables that are present in EHR-derived data will inform future interventions to improve the fidelity, accessibility and use of the EHR in clinical research.

Immediate versus delayed application of bone morphogenetic protein-2 solution in damaged extraction sockets: a preclinical in vivo investigation

To compare the clinical, radiographic, and histological healing patterns between the immediate and delayed applications of bone morphogenetic protein-2 (BMP-2) in damaged extraction sockets in dogs. The distal roots of the fourth premolars of the mandible were extracted bilaterally in five beagle dogs, and buccal bone defects (4mm wide and 9mm high) were surgically created. Collagenated biphasic calcium phosphate (CBCP) soaked for 10min in 100μL of BMP-2 solution was applied immediately to the defect site in the control group. In the test group, the BMP-2 solution of same dose was injected into the grafted site 2weeks after grafting with a saline-soaked CBCP. The dogs were sacrificed 2weeks later. Clinical, histological, and radiographic analyses were followed. Swelling and inflammatory reactions were predominantly observed in the control group at 2weeks. The area of new bone formation was significantly larger in the control group compared with the test group (10.8 ± 7.0 mm2 [mean ± SD] and 6.3 ± 3.1 mm2, respectively; p = 0.043). No significant difference was found in ridge width at 2mm, 4mm and 6mm below the lingual bone crest between the control (2.6 ± 1.0mm, 3.2 ± 0.9mm and 4.5 ± 0.5mm, respectively) and test group (3.3 ± 1.0mm, 3.7 ± 1.3mm and 4.2 ± 1.0mm; all p > 0.05). Delayed application of BMP-2 2weeks after surgery did not show any advantage over immediate application of BMP-2 in terms of new bone formation. This study suggests that it might be better to apply BMP-2 immediately in alveolar ridge preservation, instead of delayed application, in order to enhance new bone formation.

Leptomeningeal disease after surgical resection and radiosurgery for brain metastases and neurologic death: A multi-institutional analysis.

2524 Background: Postoperative radiosurgery (SRS) has been associated with up to 30% risk of subsequent leptomeningeal disease (LMD). We previously demonstrated that radiographic pattern of LMD (classical “sugarcoating” [cLMD] vs. nodular [nLMD]) in this setting is prognostic. The association between radiographic pattern of LMD, type of salvage treatment (tx), and neurologic death (ND) has not been well described. Methods: The records of patients (pts) with brain metastases (BM), of which 1 was resected and treated with adjunctive SRS, and who subsequently developed LMD were combined from 7 tertiary care centers. Pts with classically radiosensitive tumors or prior or planned whole brain radiotherapy (WBRT) were excluded. ND was defined as symptomatic CNS progression around the time of death without life threatening systemic symptoms or progression. Salvage radiotherapy (RT) for LMD was categorized according to use of WBRT vs. focal cranial RT. Results: The study cohort consisted of 147 pts, of which 125 had died with known cause, 107 also received LMD salvage tx, and 82 also had cranial MRI follow-up. The ND rate in the 125 pts who died with known cause was 79%; the rate in pts who underwent LMD salvage tx (n = 107) was 76%. Univariate logistic regression demonstrated radiographic pattern of LMD (cLMD vs. nLMD, odds ratio [OR] 2.9, p = 0.04) and 2nd LMD failure after salvage tx (OR 3.9, p = 0.02) as significantly associated with ND. The ND rate was 86% for cLMD vs. 68% for nLMD pattern. WBRT was used in 95% of pts with cLMD vs. 52% of pts with nLMD. In the nLMD cohort (n = 58), there was no difference in ND rate based on type of salvage RT (WBRT: 67% vs. focal cranial RT: 68%, p = 0.92). Second LMD failure (vs. not) was associated with higher ND in the nLMD cohort (77% vs. 52%, p = 0.02). Of the 26 pts with nLMD who experienced 2nd LMD failure, 7 had classical 2nd LMD, of which 100% experienced ND, and 19 had nodular 2nd LMD, of which 68% experienced ND (p = 0.09). Conclusions: LMD after surgery and SRS for brain metastases is a clinically significant event with high rates of neurologic death. Classical LMD pattern (vs. nodular) and 2nd LMD failure after salvage tx were significantly associated with higher risk of neurologic death. In the nodular LMD cohort, radiographic pattern of 2nd LMD may be associated with risk of subsequent neurologic death. Pts with nodular LMD treated with salvage focal cranial RT or WBRT had similar risk of neurologic death. Methods to decrease LMD and the subsequent high risk of neurologic death in this setting warrant investigation.

Radiographic patterns of symptomatic radiation pneumonitis in lung cancer patients: Imaging predictors for clinical severity and outcome

ObjectiveInvestigate the spectrum of radiographic patterns of radiation pneumonitis (RP) in lung cancer patients and identify imaging markers for high-grade RP and RP-related death. MethodsEighty-two patients with lung cancer treated with conventional chest radiotherapy who had symptomatic RP were identified from the radiation oncology database. The imaging features of RP were studied for association with high-grade RP (Grade ≥3) and RP-related death (Grade 5). ResultsRP was Grade 2 in 60 (73%), Grade 3 in 15 (18%), and Grade 5 in 7 patients (9%). Lower performance status (p = 0.04), squamous cell histology (p = 0.03), and FEV1 ≤ 2 (p = 0.009) were associated with high-grade pneumonitis. Older age (p = 0.03) and squamous cell histology (p = 0.03) were associated with RP-related death. The CT findings included ground-glass and reticular opacities in all patients, with traction bronchiectasis in 77 (94%) and consolidation in 74 (90%). The most common radiographic pattern of RP was cryptogenic organizing pneumonia (COP) pattern (n = 54), followed by acute interstitial pneumonia (AIP)/acute respiratory distress syndrome (ARDS) pattern (n = 10). Higher extent of lung involvement, diffuse distribution, and AIP/ARDS pattern were associated with high-grade pneumonitis and RP-related death. AIP/ARDS pattern was a significant factor for high-grade pneumonitis (OR:12.62, p = 0.01) in multivariable analyses adjusting for clinical variables. ConclusionCOP pattern was the most common radiographic pattern for symptomatic RP in lung cancer patients. AIP/ARDS pattern was significantly associated with high-grade RP and RP-related deaths, and was an independent marker for high-grade RP. The recognition of the radiographic patterns of RP can help to effectively contribute to patient management.

Study of the radiographic parameters of normal ankles

Objective: The authors carried out a bibliographic search for the radiographic parameters used to determine tibiotalar joint alignment, and suggest a set of parameters that constitute the minimum radiographic evaluation sufficient for the proper assessment of tibiotalar alignment. Methods: The search was conducted between May 2019 and January 2020 on the online platforms PudMed and Google Scholar with the following terms, used separately or jointly: “ankle arthritis, radiographic measurement, ankle alignment, alignment, anterior ankle instability, X-ray, and ankle injury”. Results: We selected twelve studies evaluating radiographic patterns of normal ankles, and identified a total of 15 radiographic measurements. Conclusion: The authors believe that a minimum radiographic assessment of tibiotalar alignment should include the following parameters on the anteroposterior radiograph: the distal tibial articular angle, the talar tilt and talus center migration. On the lateral radiograph, it should include: lateral distal tibial angle and lateral talar station. Level of Evidence V; Diagnostic Study; Expert Opinion.

Point-of-Care Bone Age Evaluation: The Increasing Role of US in Resource-limited Populations

Point-of-Care Bone Age Evaluation: The Increasing Role of US in Resource-limited Populations

RETRACTED ARTICLE: Deep learning system to screen coronavirus disease 2019 pneumonia

Radiographic patterns on CT chest scans have shown higher sensitivity and specificity compared to RT-PCR detection of COVID-19 which, according to the WHO has a relatively low positive detection rate in the early stages. We technically review a study that compared multiple convolutional neural network (CNN) models to classify CT samples with COVID-19, Influenza viral pneumonia, or no-infection. We compare this mentioned study with one that is developed on existing 2D and 3D deep-learning models, combining them with the latest clinical understanding, and achieved an AUC of 0.996 (95%CI: 0.989–1.00) for Coronavirus vs Non-coronavirus cases per thoracic CT studies. They calculated a sensitivity of 98.2% and a specificity of 92.2%.

Patients with Interstitial Lung Disease Secondary to Autoimmune Diseases: How to Recognize Them?

The diagnostic assessment of patients with Interstitial Lung Disease (ILD) can be challenging due to the large number of possible causes. Moreover, the diagnostic approach can be limited by the severity of the disease, which may not allow invasive exams. To overcome this issue, the referral centers for ILD organized Multidisciplinary Teams (MDTs), including physicians and experts in complementary discipline, to discuss the management of doubtful cases of ILD. MDT is currently considered the gold standard for ILD diagnosis, but it is not often simple to organize and, furthermore, rheumatologists are still not always included. In fact, even if rheumatologic conditions represent a common cause of ILD, they are sometimes difficult to recognize, considering the variegated clinical features and their association with all possible radiographic patterns of ILD. The first objective of this review is to describe the clinical, laboratory, and instrumental tests that can drive a diagnosis toward a possible rheumatic disease. The secondary objective is to propose a set of first-line tests to perform in all patients in order to recognize any possible rheumatic conditions underlying ILD.

Gambaran Radiografi Tuberkulosis Paru Multidrug-Resistant: Studi Retrospektif di Rumah Sakit Umum Dr. Soetomo Surabaya

Background: Multidrug-resistant pulmonary tuberculosis (MDR-TB) is a major health problem worldwide. Prompt diagnosis is necessary for insuring appropriate therapy to lower morbidity and mortality, as well as to prevent disease transmission. Determination of drug-resistance patterns through microbiological examination is sometimes challenging, especially when the sputum acid-fast bacilli smear is negative. Therefore, it is worthwhile to investigate whether there may be radiographic patterns suggesting MDR-TB infection. The objective of this study was to evaluate the radiographic features of MDR-TB. Methods: From September 2015 to March 2018, 167 patients with microbiologically proven MDR-TB were enrolled in the study. All radiographs were obtained before the patients received MDR-TB chemotherapy regimen. Posterior-anterior chest radiography was performed using digital radiography system (Hitachi Radnext50 500mAs) and retrospectively reviewed as digital raw data. Results: Based on severity category, 60% had severe lesion, 31% had moderate lesion, and only 9% had mild lesion. The most frequently observed findings were ground glass opacity or consolidation, noted in 96% patients, with bilateral lung involvement in 81% patients; fibrosis (95%), cavity (78%; 87% of which were multiple), interstitial opacities (53%), pleural thickening and mediastinal shift (59%). Other radiological findings were calcification (16%), emphysema (13%), lung destruction (12%), atelectasis (10%), nodule (8%), bullae (8%), bronchiectasis (5%), miliary pattern (1%), pleural effusion (25%), pneumothorax (1%), and hilar lymphadenopathy (14%) which predominantly unilateral. Conclusion: The presence of severe pulmonary lesion, ground glass opacity or consolidation with bilateral lung involvement, fibrosis, multiple cavities, interstitial opacities, pleural thickening, and mediastinal shift are the main features of MDR-TB.

Changing trabecular patterns in panoramic radiographs of Swedish women during 25 years of follow-up.

The radiographic trabecular pattern on dental radiographs may be used to predict fractures. The aim of this study was to analyze longitudinal changes in the mandibles of 145 females between 1980 and 2005. Panoramic radiographs were obtained in 1980 and 2005. On 290 radiographs, regions of interest (ROIs) were selected in the ramus, angle and body. In all ROIs, the orientation was measured in 36 directions with the line frequency deviation method. The effects of ageing were analyzed for the fracture and the non-fracture groups separately. During the follow-up, 61 females suffered fractures of the hip, wrist, spine, leg or arm. The fracture and non-fracture groups displayed dissimilar age changes in each investigated ROI. All significant changes pertained to increasing values of line frequency deviation. With increasing age, the trabecular network in the mandible lost details and the trabeculae became more aligned in their main direction. In the "ramus", the alignment was to the 110-120˚ axis, parallel to the posterior and anterior ramus border. In the "angle", the alignment was to the 135-150˚ axis, parallel to the oblique line, and in the "body" ROI to the 150-175˚ direction, approximately parallel to the occlusal plane and inferior cortex. Most changes were consistent with the notion that the bone aged less severely in the non-fracture group. In the fracture group, the findings indicate that bone loss leads to redistribution of the remaining bone tissue in such a way that the trabeculae are accentuated perpendicular to the principal loading.

Usability of the AAOS Appropriate Use Criteria (AUC) for the surgical management of knee osteoarthritis in clinical practice

PurposeThe Appropriate Use Criteria (AUC) for the surgical treatment of knee osteoarthritis were developed by the American Academy of Orthopedic Surgeons (AAOS) to guide surgeons in selecting the most evidence-based surgical option. This study aimed to assess the usability of the AUC by comparing the actual surgical treatment provided at our institution with that recommended by the AUC.MethodsA retrospective review of the medical charts and radiographs of all patients who underwent surgery for knee osteoarthritis (OA) at our hospital was performed between January and December 2017. Data including each patient’s age, gender, pain level, mechanical symptoms, range of motion (ROM) and instability, radiographic pattern and severity, limb alignment, and type of surgical interventions received were collected.The collected data were input into the AUC application to determine the rate of appropriateness of the treatments. Afterwards, the agreement between the actual treatment provided and the AUC recommendation was assessed.ResultsA consecutive series of 100 patients were included. The mean age was 63.1 years, with the majority of the patients aged (73%) between 50 and 69 years. Most of the patients were females (74%), and 61% had left knee OA. The most frequent type of patient was a middle-aged patient with function-limiting pain at short distances, no mechanical symptoms or functional instability with full ROM, severe knee multicompartmental radiographic features, and varus or valgus malalignment. Out of the 100 patients, total knee arthroplasty (TKA) was performed in 85 patients, unicompartmental knee arthroplasty (UKA) was performed in 11 patients, and high tibial osteotomy (HTO) was performed in four patients.According to the AUC, 90 (90%) cases were treated with an appropriate surgical treatment, whereas 10 (10%) cases were treated with a maybe appropriate treatment. The actual surgical treatment performed at our hospital was in agreement with the AUC recommendation in 100% of the TKA cases, 90.9% of the UKA cases, and 100% of the HTO cases. Thus, the agreement rate with the AUC was 99% in all surgical cases.ConclusionThis study demonstrated that the AUC for the surgical treatment of knee OA can be applied easily in a clinical setting. Most of the treatments provided at our institution were appropriate and in agreement with the AUC recommendations. Additionally, the AUC had a web-based application that was easy to use and simple for identifying treatment recommendations.Level of evidenceRetrospective study, level IV.

Pneumocystis jiroveci.

Pneumocystis jiroveci remains an important fungal pathogen in a broad range of immunocompromised hosts. The natural reservoir of infection remains unknown. Pneumocystis jiroveci Pneumonia (PJP) develops via airborne transmission or reactivation of inadequately treated infection. Nosocomial clusters of infection have been described among immunocompromised hosts. Subclinical infection or colonization may occur. Pneumocystis pneumonia occurs most often within 6 months of organ transplantation and with intensified or prolonged immunosuppression, notably with corticosteroids. Infection is also common during neutropenia and low-lymphocyte counts, with hypogammaglobulinemia, and following cytomegalovirus (CMV) infection. The clinical presentation generally includes fever, dyspnea with hypoxemia, and nonproductive cough. Chest radiographic patterns are best visualized by computed tomography (CT) scan with diffuse interstitial processes. Laboratory examination reveals hypoxemia, elevated serum lactic dehydrogenase levels, and elevated serum (1→3) β-D-glucan assays. Specific diagnosis is achieved using respiratory specimens with direct immunofluorescent staining; invasive procedures may be required and are important to avoid unnecessary therapies. Quantitative nucleic acid amplification is a useful adjunct to diagnosis but may be overly sensitive. Trimethoprim-sulfamethoxazole (TMP-SMX) remains the drug of choice for therapy; drug allergy should be documented before resorting to alternative therapies. Adjunctive corticosteroids may be useful early in the clinical course; aggressive reductions in immunosuppression may provoke immune reconstitution syndromes. Pneumocystis pneumonia (PJP) prophylaxis is recommended and effective for immunocompromised individuals in the most commonly affected risk groups.

Clinical and Radiographic Aspects of Metacarpal Remodeling Secondary to a Rubber Band (Latex) Compression in a Dog

Background: Musculoskeletal disorders are a common complaint in veterinary small animal casuistic. Along with fractures, degenerative and of carcinogenic etiology are the most frequent and radiographic lesion pattern at these diseases is relative well defined. However, traumatic lesions, considering its innumerous possibilities, may cause unusual clinical and radiographic signs which will delay diagnosis and consequently, adequate treatment. A case of bone osteolysis caused by a compressive trauma by a rubber band is described with its clinical, laboratorial and radiographic aspects.Case: A 2-year-old female dog was attended at the Veterinary Hospital of the Dom Bosco Catholic University (UCDB), with main complaint being an unresponsive to treatment lesion at the left thoracic limb. At physical examination it was observed lameness of the left thoracic limb with an ulcerative lesion at the palmar surface. At the center of the ulcer a 0.3 cm line shaped yellow object was identified, similar to a rubber band. Traction was made and the object distended 5 cm without breaking nor leaving the injury. Showing signs of discomfort, the patient was then sedated for further manipulation. A blood sample for complete blood count and serum biochemistry was collected and radiographic image of the left carpometacarpal-phalangeal region was acquired. Blood analysis revealed moderate thrombocytopenia with an unremarkable serum biochemistry profile (alanine aminotransferase, alkaline phosphatase, creatinine and urea). It was observed metacarpals with increased radiopacity in bone tissue in the mid-diaphysis topography of the II, III, IV and V metacarpal bones, presence of bone remodeling with radiolucent area and slight bone loss (osteolysis) in the mid-diaphysis associated with discrete sclerosis of the medullary cavity of the II, III and V metacarpals. The patient was submitted to surgery and a 3 cm incision was made following the way of the foreign body, with a small traction the object was removed, confirming the presence of a rubber band. Post-surgery prescription included systemic antibiotic, non-steroidal anti-inflammatory, analgesic and topical ointment. Twenty-two days post-surgery, at revaluation, it was observed only discrete improvement of bone remodeling of V metacarpal but with complete wound healing and full recovery of the lameness.Discussion: It was unclear the reason that led to the presence of the rubber band. Unfortunately, the owner could only complaint about at wound that would not heal for weeks. The best hypothesis was the possible use of a beauty accessory after a bathing service. Considering the patient’s long hair, detachment of any accessory to a rubber band base could have gone unnoticed. Definition regarding the time period since the initial trauma would define for how long the compression was necessary to induce metacarpal remodeling, but the presence of the foreign body and consequently, continuous stimulus of inflammation, would not permit a precise definition regarding the time period of the lesion, even if histopathology was authorized. Surgical removal of the rubber band associated with non-steroidal anti-inflammatory, analgesic, systemic and topical antibiotic (ointment) was considered satisfactory, leading to considerable improvement (normal gait) of the nociception and lameness at day three post-intervention and despite persistence of the bone radiographic aspect, full recovery of the skin lesion at day twenty-two.

Classification of Interstitial Lung Abnormality Patterns with an Ensemble of Deep Convolutional Neural Networks

Subtle interstitial changes in the lung parenchyma of smokers, known as Interstitial Lung Abnormalities (ILA), have been associated with clinical outcomes, including mortality, even in the absence of Interstitial Lung Disease (ILD). Although several methods have been proposed for the automatic identification of more advanced Interstitial Lung Disease (ILD) patterns, few have tackled ILA, which likely precedes the development ILD in some cases. In this context, we propose a novel methodology for automated identification and classification of ILA patterns in computed tomography (CT) images. The proposed method is an ensemble of deep convolutional neural networks (CNNs) that detect more discriminative features by incorporating two, two-and-a-half and three- dimensional architectures, thereby enabling more accurate classification. This technique is implemented by first training each individual CNN, and then combining its output responses to form the overall ensemble output. To train and test the system we used 37424 radiographic tissue samples corresponding to eight different parenchymal feature classes from 208 CT scans. The resulting ensemble performance including an average sensitivity of 91,41% and average specificity of 98,18% suggests it is potentially a viable method to identify radiographic patterns that precede the development of ILD.

Cardiac wall motion abnormality as a predictor for undetermined stroke with embolic lesion-pattern

ObjectivesSeveral strokes of potential embolism do not clearly meet the definitions of embolic stroke with unknown source, cryptogenic stroke, or cardioembolic (CE) stroke. Considering the high mortality and recurrence of CE strokes, it is very important to detect treatable cardiac sources of embolism. Although regional wall motion abnormality (RWMA) of the left ventricle (LV) seems to be related to CE stroke, association between cerebral embolic risk and RWMA remains unclear. The purpose of this study was to investigate the influence of RWMA on undetermined stroke with embolic lesion-pattern (USELP). Patients and methodsAmong a total of 2327 patients with acute ischemic stroke, we excluded 148 patients without a transthoracic echocardiography (TTE). According to a stepwise approach, we excluded patients without an embolic lesion-pattern. Finally, we divided patients into two groups (USELP, 119, and non-embolic stroke, 1237). We classified patients’ RWMAs into three major arterial territories according to the standard 17-segment model of TTE. ResultsAmong the included 1356 patients, those with USELP had larger internal dimension at diastole and systole in LV, reduced LV ejection fraction, increased E/A ratios, mitral valve disease, and RWMA. After adjusting for multiple variables, binary logistic regression revealed that RWMA was significantly associated with USELP (OR 7.02, 95 % CI: 3.51–14.01, p<0.001). ConclusionThis study provides significant information to support that RWMA can be a predictor for undetermined embolic stroke. In this regard, RWMA were highly correlated with patients whose imaging supported an embolic source compared to those without this radiographic pattern.

Radiographic Characteristics of Soft Tissue Calcification on Digital Panoramic Images

Objective: To assess the prevalence of soft tissue calcifications and their panoramic radiographic characteristics. Material and Methods: This descriptive retrospective study evaluated 2027 panoramic radiographs. The type and location of calcifications and the age and gender of patients were evaluated by two radiologists. Data were analyzed via SPSS and the Chi-square, Fisher’s exact and Kappa tests were used to compare the categorical demographic variables among the groups. The confidence interval was set to 95% and p<0.05 was considered statistically significant . Results: The prevalence of calcified stylohyoid ligament was 11.24%. This value was 3.99% for tonsillolith, 1.33% for calcified carotid plaque, 0.69% for antrolith, 0.39% for calcified lymph node, 0.29% for phleboliths, and 0.19% for sialoliths. The prevalence of these conditions had no significant association with gender or age (p=0.102). The prevalence of bilateral calcified stylohyoid ligament, tonsillolith, and a calcified carotid plaque was significantly higher (p<0.001). The most prevalent type of calcified stylohyoid ligament, according to O'Carroll’s classification, belonged to types 1, 4, 3 and 2 (p<0.001). The most commonly observed radiographic pattern was multiple, well-defined tonsilloliths (75.3%, p<0.001) . Conclusion: The prevalence of soft tissue calcifications on panoramic radiographs was relatively low in this Iranian population. The most calcifications were respectively calcified stylohyoid ligament, tonsillolith, calcified carotid plaque, antrolith, calcified lymph node, phleboliths and sialoliths . Calcified stylohyoid ligament, tonsillolith and calcified carotid plaque were more bilaterally. Thereby panoramic imaging can help in primary assessment, epidemiologic and screening evaluation of these calcifications.

Correlation of Radiographic Findings of Sacroiliac Joint with Clinical Profile in Patients with Inflammatory Low Back Pain: An Observational Study

Introduction: Inflammatory back pain (IBP) is a prominent clinical symptoms in patients with spondyloarthropathy (SpA) affecting young adults and is an important cause of morbidity in the productive age group. SpA characteristically involves sacroiliac joints (SIJs). For the diagnosis of early sacroiliitis, though magnetic resonance imaging (MRI) is the preferred method, conventional radiography has been routinely used for the evaluation of sacroiliitis. Active inflammation in SIJs cannot be assessed on radiographs and they usually appear normal in the early phase of IBP. This study aims to study the clinical and radiographic patterns of IBP in Indian scenario. Materials and Methods: Treatment naive patients with low back pain and subsequently diagnosed with IBP as per Calin criteria were identified. The clinical and laboratory parameters of these patients were recorded. SIJ radiographs of these patients were analyzed. Results: Fifty-two patients were registered with 57% of subjects being female. The mean age of onset of symptoms was 32–33 years with a mean duration of symptoms being 40.9 months. No significant difference was noted in the age of onset or duration of illness in males and females. Human leukocyte antigen-B27 (HLA-B27) positivity rate was only 8.7%. About 38.4% of cases demonstrated active inflammation at presentation. Most of the cases (94.2%) though presented for the first time had radiographic evidence of sacroiliitis. A maximum number of cases (38.4%) were seen in Grade 2, followed by Grade 3 (30.8%). Cases with symmetrical sacroiliitis were more (57.1%) as compared to asymmetrical/unilateral sacroiliitis. HLA-B27 positivity in symmetric cases was 10.9% as against 12.5% in asymmetric cases. Conclusions: There is often delay in the diagnosis of sacroiliitis. This is, in contrast, to profile in developed nations where early detection of the disease occurs ultimately leading to the usefulness of early therapy. Appropriate measures need to be taken in the health-care sector to increase awareness among people and treating physicians and sensitize them to IBP and its associated morbidities. In the present scenario, where the majority of cases are presenting in the chronic stage of the disease, radiography may be advocated in resource poor areas to decrease burden and cost related to the use of MRI.