Sensitivity For Detection Of Lesions Research Articles

Decoding incidental ovarian lesions: use of texture analysis and machine learning for characterization and detection of malignancy.

To compare CT texture features of benign and malignant ovarian lesions and to build a machine learning model to detect malignancy in incidental ovarian lesions. In this IRB-approved, HIPAA-compliant, retrospective study, 427 consecutive patients with incidental ovarian lesions detected on contrast-enhanced CT (348, 81.5% benign and 79, 18.5% malignant) were included. The following CT texture features were analyzed using commercially available software (TexRAD, Feedback Plc, Cambridge, UK): total pixel, mean, standard deviation (SD), entropy, mean value of positive pixels (MPP), skewness, kurtosis and entropy. Three machine learning models were created by combining texture features and patients' age, and performance of these models was assessed using tenfold cross-validation. Receiver operating characteristics (ROC) were constructed to assess sensitivity and specificity. The cutoff value was picked using a cost-weighted method. Total pixels, mean, SD, entropy, MPP, and skewness were significantly different between benign and malignant groups (p < 0.05). With a selected 10 as a cost factor to optimize cutoff value selection, sensitivity 92%, specificity 60% in the random forest (RF) model, sensitivity 91%, specificity 69% in SVM model, and sensitivity 92%, specificity 61% in the logistic regression, respectively. CT texture analysis could provide objective imaging analysis of incidental ovarian lesions and ML models using CT texture features and age demonstrated high sensitivity and moderate specificity for detection of malignant lesions.

Ultra-high field 7 T imaging in multiple sclerosis.

Ultra-high field 7 T MRI has multiple applications for the in vivo characterization of the heterogeneous aspects underlying multiple sclerosis including the identification of cortical lesions, characterization of the different types of white matter plaques, evaluation of structures difficult to assess with conventional MRI (thalamus, cerebellum, spinal cord, meninges). The sensitivity of cortical lesion detection at 7 T is twice than at lower field MRI, especially for subpial lesions, the most common cortical lesion type in multiple sclerosis. Cortical lesion load accrual is independent of that in the white matter and predicts disability progression.Seven Tesla MRI provides details on tissue microstructure that can be used to improve white matter lesion characterization. These include the presence of a central vein, whose identification can be used to improve multiple sclerosis diagnosis, or the appearance of an iron-rich paramagnetic rim on susceptibility-weighted images, which corresponds to iron-rich microglia at the periphery of slow expanding lesions. Improvements in cerebellar and spinal cord tissue delineation and lesion characterization have also been demonstrated. Imaging at 7 T allows assessing more comprehensively the complementary pathophysiological aspects of multiple sclerosis, opening up novel perspectives for clinical and therapeutics evaluation.

Optimization of the radiosynthesis of [68Ga]Ga-PSMA-11 using a Trasis MiniAiO synthesizer: do we need to heat and purify?

The radiosynthesis of [Ga]Ga PSMA-11 was performed using a Trasis MiniAio synthesizer and a Ge/Ga GalliaPharm generator supplied by Eckert & Ziegler, Berlin, Germany. Optimized labeling parameters were evaluated by variation of sodium acetate concentrations and temperature of radiolabeling as well as the purification process. For each condition tested, radiochemical purity was higher than 99% in the final vial without batch failure, indicating a robust and fast radiosynthesis process. Radiosynthesis without the solid phase extraction purification process at room temperature in less than 5 min resulted in a radiolabeling efficiency of over 99% and remained stable at least 4 h without manual processing to limit operator radiation exposure. The procedure was completely automated and provided a high radiochemical yield. It can be performed several times a day, facilitating the clinical demand of this radiopharmaceutical.

Vestibular Evoked Myogenic Potential in Multiple Sclerosis (MS)

Background: Involvement of the brainstem in multiple sclerosis [MS] has significant implications on the disease course and can be presented with different symptoms. There are many tests able to detect brain-stem involvement in MS with various degrees of success.Aim of the work: To study the changes in vestibular evoked myogenic potential [VEMP], in patients with MS, and to detect its sensitivity for detection of the brain-stem lesions previously diagnosed with magnetic resonance imaging [MRI] in MS patients.Patients and Methods: Sixty participants had been enrolled and divided into two groups: 30 healthy subjects [Control group] and 30 MS patients [Study group]. Both groups had been subjected to otological examinations, pure tone audiometry, acoustic impedance, cervical vestibular evoked myogenic potential [cVEMP], ocular vestibular evoked myogenic potential [oVEMP] and MRI. Results: In MS group, oVEMP mean latencies of n1 and p1 and cVEMP mean p13 and n23 latencies were significantly prolonged. In addition, 14 MS patients [46.7%] had brainstem lesions as confirmed by MRI. Finally, oVEMP test had higher sensitivity than the cVEMP in prediction of brainstem lesions.Conclusion: oVEMP seems to be useful and more sensitive than cVEMP as an adjunct test in the evaluation of brain-stem dysfunction in MS patients.

Influence of the Location and Zone of Tumor in Prostate Cancer Detection and Localization on 3-T Multiparametric MRI Based on PI-RADS Version 2.

OBJECTIVE. The objective of our study was to determine the performance of 3-T multiparametric MRI (mpMRI) for prostate cancer (PCa) detection and localization, stratified by anatomic zone and level, using Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) and whole-mount histopathology (WMHP) as reference. MATERIALS AND METHODS. Multiparametric MRI examinations of 415 consecutive men were compared with thin-section WMHP results. A genitourinary radiologist and pathologist collectively determined concordance. Two radiologists assigned PI-RADSv2 scores and sector location to all detected foci by consensus. Tumor detection rates were calculated for clinical and pathologic (tumor location and zone) variables. Both rigid and adjusted sector-matching models were used to account for fixation-related issues. RESULTS. Of 863 PCa foci in 16,185 prostate sectors, the detection of overall and index PCa lesions in the midgland, base, and apex was 54.9% and 83.1%, 42.1% and 64.0% (p = 0.04, p = 0.02), and 41.9% and 71.4% (p = 0.001, p = 0.006), respectively. Tumor localization sensitivity was highest in the midgland compared with the base and apex using an adjusted match compared with a rigid match (index lesions, 71.3% vs 43.7%; all lesions, 70.8% vs 36.0%) and was greater in the peripheral zone (PZ) than in the transition zone. Three-Tesla mpMRI had similarly high specificity (range, 93.8-98.3%) for overall and index tumor localization when using both rigid and adjusted sector-matching approaches. CONCLUSION. For 3-T mpMRI, the highest sensitivity (83.1%) for detection of index PCa lesions was in the midgland, with 98.3% specificity. Multiparametric MRI performance for sectoral localization of PCa within the prostate was moderate and was best for index lesions in the PZ using an adjusted model.

Rapid study assessment in follow-up whole-body computed tomography in patients with multiple myeloma using a dedicated bone subtraction software.

The diagnostic reading of follow-up low-dose whole-body computed tomography (WBCT) examinations in patients with multiple myeloma (MM) is a demanding process. This study aimed to evaluate the diagnostic accuracy and benefit of a novel software program providing rapid-subtraction maps for bone lesion change detection. Sixty patients (66years ± 10years) receiving 120 WBCT examinations for follow-up evaluation of MM bone disease were identified from our imaging archive. The median follow-up time was 292days (range 200-641days). Subtraction maps were calculated from 2-mm CT images using a nonlinear deformation algorithm. Reading time, correctly assessed lesions, and disease classification were compared to a standard reading software program. De novo clinical reading by a senior radiologist served as the reference standard. Statistics included Wilcoxon rank-sum test, Cohen's kappa coefficient, and calculation of sensitivity, specificity, positive/negative predictive value, and accuracy. Calculation time for subtraction maps was 84s ± 24s. Both readers reported exams faster using subtraction maps (reader A, 438s ± 133s; reader B, 1049s ± 438s) compared to PACS software (reader A, 534s ± 156s; reader B, 1486s ± 587s; p< 0.01). The course of disease was correctly classified by both methods in all patients. Sensitivity for lesion detection in subtraction maps/conventional reading was 92%/80% for reader A and 88%/76% for reader B. Specificity was 98%/100% for reader A and 95%/96% for reader B. A software program for the rapid-subtraction map calculation of follow-up WBCT scans has been successfully tested and seems suited for application in clinical routine. Subtraction maps significantly facilitated reading of WBCTs by reducing reading time and increasing sensitivity. • A novel algorithm has been successfully applied to generate motion-corrected bone subtraction maps of whole-body low-dose CT scans in less than 2min. • Motion-corrected bone subtraction maps significantly facilitate the reading of follow-up whole-body low-dose CT scans in multiple myeloma by reducing reading time and increasing sensitivity.

Prospective Comparison of Reduced Field-of-View (rFOV) and Full FOV (fFOV) Diffusion-Weighted Imaging (DWI) in the Assessment of Insulinoma: Image Quality and Lesion Detection

To prospectively compare the image quality (IQ) and lesion detection performance of reduced field-of-view (rFOV) and full FOV (fFOV) diffusion-weighted imaging (DWI) sequences in detecting insulinomas. From October 2017 to September 2018, 67 patients with suspected insulinomas were prospectively enrolled and underwent imaging with both types of DWI sequences. The slice thickness (4 mm) and slice gaps (1 mm) were the same for the two DWI sequences, and the TR/TE was 2235/56 ms for the rFOV sequence and 1892/63 ms for the fFOV sequence. Three radiologists independently assessed the imaging quality (IQ) subjectively with a 5-point scale and objectively with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements. The IQ scores, CNR, SNR, lesion detection rates, and ADC values were compared. Receiver operating characteristic curves were generated, and the area under the curve (AUC) was used to compare the diagnostic performance. Fifty patients were tumor positive, with 65 tumors (size: 1.31 ± 0.77 cm, range: 0.6-5.8 cm). The IQ score, SNR, and CNR were significantly higher for rFOV DWI than for fFOV DWI (IQ: 3.64 ± 0.487 vs 3.310 ± 0.577, SNR: 22.520 ± 8.690 vs 10.284 ± 3.321, CNR: 3.454 ± 2.642 vs 1.327 ± 2.801, and all p < 0.05). For lesions less than 1.5 cm (n = 55), the lesion detection rates of the rFOV were statistically improved compared to those of the fFOV (90.7% vs. 75.9%, p = 0.039). The sensitivity of lesion detection was significantly improved with the rFOV-DWI sequences compared to that with the fFOV-DWI sequences (0.924 vs. 0.773, p = 0.013). The ADC values of the two DWI sequences were consistent for insulinomas and normal parenchyma. Considering the improvements in overall IQ and lesion detection and the consistency of ADC measurements, we suggest that rFOV DWI is a reliable auxiliary alternative to fFOV DWI for clinical practice in the detection of pancreatic insulinomas.

Detection and Local Staging of Prostate Cancer by 68Ga-PSMA-PET/CT, Comparison with mpMRI and Histopathology

Introduction: 68Ga-PSMA-PET/CT has proven its value in prostate cancer with high positive predictive value for lymph node metastasis and superior detection of distant metastasis. There is growing evidence that 68Ga-PSMA- PET/CT has high sensitivity for detection of tumor lesions in the prostate as well. Studies thus far have mainly been performed in patients prior to prostatectomy. Aim of this study is to evaluate diagnostic accuracy in a mixed population of men with increased risk of prostate cancer and evaluate diagnostic possibilities with respect to extra-capsular extension and seminal vesicle invasion. Methods: The population consisted of a retrospectively included sequential cohort of 69 patients with 68Ga-PSMA-PET/CT and mpMRI available. 68Ga-PSMA-PET/CT was re-evaluated by two readers blinded for mpMRI and clinical information. Likelihood of tumour presence, extra-prostatic extension and seminal vesicle invasion was scored on 5-point Likert scale and localized schematically. Results were compared with mpMRI. Available pathological outcome served as gold standard. SUVmax of index lesions was measured and correlated to index tumor Gleason grade. Results: Clinically significant prostate cancer (Gleason ≥ 3 + 4) was detected in 57 (83%) of 69 patients. Diagnostic accuracy was 89% for PET reader 1, 93% for PET reader 2 and 86% for mpMRI. Lesion concordance of 68Ga-PSMA-PET/CT and mpMRI was 97%. SUVmax of the index lesion correlated to Gleason grade. Sensitivity for extracapsular extension in the prostatectomy group was 62% for PET reader 1, 33% for PET reader 2 and 50% for mpMRI. Specificity was 62% for PET reader 1, 100% for PET reader 2 and 69% for mpMRI. Conclusion: Ga68-PSMA-PET shows high accuracy in the detection of tumor lesions in the prostate. Results on evaluating extra-capsular extension and seminal vesicle invasion are comparable to mpMRI. This study adds to the increasing evidence that 68Ga-PSMA-PET/CT is imperative in detection of prostate cancer prior to biopsy.

Diagnostic accuracy of double inversion recovery in delineation of multiple sclerosis lesions and its clinical correlation with expanded disability scoring system

BackgroundThe aim of our work was to assess the diagnostic accuracy of a double inversion recovery (DIR) sequence in the detection of brain and spinal cord MS lesions. In addition, we aimed to evaluate the reliability of the correlation between GM affection and high Expanded Disability Status Scale (EDSS) to enhance the role of DIR as a practical test for clinical disability. Ninety MS patients were prospectively included in this study. Imaging was performed using Philips Intera 1.5 Tesla device. T2W-TSE, FLAIR, and DIR sequences were performed and compared to each other. Each patient was clinically assessed at the time of the MRI examination with EDSS.ResultsDIR showed significantly higher total lesion load in comparison to T2 and FLAIR with increased sensitivity for cortical lesion detection by DIR. There was a positive association between patients with cortical lesions and male gender, clinical disability, cognitive changes, and higher EDSS score.ConclusionThe increased rate of cortical lesion detection by DIR does not affect its accuracy in white matter lesions count. Moreover, DIR provided a better morphological characterization and delineation of white matter lesion with good differentiation between juxtacortical and mixed white matter–gray matter lesions; thus, we recommend adding DIR sequence in routine MR protocols for MS patients.

Side‐Viewing Endoscopic Raman Spectroscopy for Angle‐Resolved Analysis of Luminal Organs

AbstractThere are many medical applications requiring angle‐resolved analysis of luminal organs. One example is lung cancer detection. Early diagnosis is the most effective way to tackle this disease. This, however, remains a challenge due to the lack of accurate detection technology. The problem is exacerbated in cases of peripheral lung cancer growing on narrow bronchi that are difficult to probe. Here, an endoscopic Raman spectroscopy device is demonstrated with a side‐viewing functionality that enables circumferential scanning spectral measurements inside thin conduits. A tubular micro rotary stepping actuator is custom‐designed and integrated with a Raman probe, for the first time, to scan a probing laser beam sideways for angle‐resolved local Raman analysis with no aid of tissue labeling, toward enabling detection of lesion‐induced biochemical changes in vivo and in real time. A microfabricated prototype is evaluated using test chemicals, harvested animal lung tissue ex vivo, as well as a murine colon model in situ and human skin in vivo. All the test results show excellent agreements with reported reference data while revealing &gt;99% wavenumber accuracies. The study indicates that microactuator‐assisted endoscopic Raman spectroscopy is a promising technology for luminal tissue analysis and encourages further studies of its sensitivity in lesion detection.

Combined gadoxetic acid and gadobenate dimeglumine enhanced liver MRI: a parameter optimization study.

To demonstrate the feasibility of combined delayed-phase gadoxetic acid (GA) and gadobenate dimeglumine (GD) enhanced liver MRI for improved detection of liver metastases, and to optimize contrast agent dose, timing, and flip angle (FA). Fourteen healthy volunteers underwent liver MRI at 3.0T at two visits during which they received two consecutive injections: 1. GA (Visit1 = 0.025mmol/kg; Visit 2 = 0.05mmol/kg) and 2. GD (both visits = 0.1mmol/kg) 20min after GA administration. Two sub-studies were performed: Experiment-1 Eight subjects underwent multi-phase breath-held 3D-fat-saturated T1-weighted spoiled gradient echo (SGRE) imaging to determine the optimal imaging window for the combined GA + GD protocol to create a homogeneously hyperintense liver and vasculature ("plain-white-liver") with maximum contrast to muscle which served as a surrogate for metastatic lesions in both experiments. Experiment-2 Six subjects underwent breath-held 3D-fat-saturated T1-weighted SGRE imaging at three different FA to determine the optimal FA for best image contrast. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were evaluated. Experiment-1 The combined GA + GD protocol created a homogeneously hyperintense liver and vasculature with maximum CNR liver/muscle at approximately 60-120s after automatic GD-bolus detection. Experiment-2 Flip angles between 25° and 35° at a dose of 0.025mmol/kg GA provided the best combination that minimized liver/vasculature CNR, while maximizing liver/muscle CNR. CNR performance to achieve a "plain-white-liver" was superior with 0.025mmol/kg GA compared to 0.05mmol/kg. Combined GA + GD enhanced T1-weighted MRI is feasible to achieve a homogeneously "plain-white-liver". Future studies need to confirm that this protocol can improve sensitivity of liver lesion detection in patients with metastatic liver disease.

2609 Use of Dotatate Scan to Establish Diagnosis of a Neuroendocrine Tumor

INTRODUCTION: Neuroendocrine tumors (NETs) are rare malignancies, defined at a cellular level by the presence of somatostatin receptors, which has recently been exploited in the development of positron-emitting somatostatin analogs for use in the 68-Gallium DOTATATE PET scan (hereafter “Dotatate scan”). Compared to previously-used technology, the Dotatate scan has shown dramatic improvements in sensitivity for lesion detection. The Dotatate scan exposes patients to lower doses of radiation, and is completed much more quickly. We present a case of a new diagnosis of a neuroendocrine tumor that illustrates multiple benefits of Dotatate scan including improved lesion detection and characterization which quickly led to changes in the treatment plan for a patient who previously was given a presumptive diagnosis of advanced pancreatic adenocarcinoma. CASE DESCRIPTION/METHODS: A 52-year-old man with history of two episodes of pancreatitis presented with one day of acute-onset epigastric pain, diarrhea, and nausea. Initial ultrasound and computed tomography (CT) scan demonstrated numerous hypervascular lesions in the liver, a mesenteric mass with associated lymphadenopathy, and a possible pancreatic tail lesion, leading to clinical concern for pancreatic adenocarcinoma. Upon further questioning, the patient reported 12–18 months of intermittent flushing and rash. A Dotatate scan revealed increased avidity in the hepatic and mesenteric lesions suggestive of carcinoid malignancy. The improved lesion characterizations provided by the Dotatate scan were useful for identifying the larger small bowel lesion as the likely primary tumor, as well as for surgical planning for debulking. Subsequent serum and urine tests were consistent with carcinoid malignancy, and a biopsy of a liver lesion confirmed the diagnosis of metastatic carcinoid tumor. The pancreatic lesion also demonstrated uptake on the scan, most consistent with a metastasis to the pancreas, with a confirmatory biopsy via endoscopic ultrasound pending. DISCUSSION: We demonstrate the utility of the Dotatate scan to support the rapid diagnosis of a neuroendocrine tumor, to assist in identification of the likely primary lesion, and to better characterize the extent of disease. Dotatate scans have been infrequently used due to novelty and cost, but cases such as this demonstrate that the cost can be well-justified in the right clinical setting.

Accuracy, Sensitivity and Specificity of Oral Brush Cytology in the Diagnosis of Oral Epithelial Lesions

Background: Oral Squamous cell carcinoma (SCC) is highly prevalent in Pakistan than the rest of the world. Five-year survival rate is 80% if SCC is diagnosed at an early stage. The survival rate declines to 20% if diagnosed at a later stage. The objective of the present study was to find out the usefulness of oral brush cytology in detecting oral lesions.&#x0D; Material and Methods: In the present prospective observational study, 88 samples were collected from Maxillofacial Surgery Out-Patient Department (OPD), Liaquat University Hospital and ISRA University Hospital from July 2015 to December 2015. After taking written informed consent, oral brush cytology was performed and stained with standard Papanicolaou (PAP) staining protocol. The biopsy of the patients was performed by standard protocols of oral biopsy and specimen preserved in 10% buffered formalin. Cross tabulation between diagnosis of brush cytology and biopsy of same patients was done and accuracy, sensitivity and specificity were calculated.&#x0D; Results: According to the distribution of patients on brush cytology, 59.1% patients were diagnosed with malignant tumors, whereas 17.1% had benign tumors. On biopsy of the same patients, squamous cell carcinoma was confirmed in 72.7% and benign tumors were found in 17% of the patients. Comparison of brush cytology with biopsy of same patients revealed no significant difference. Accuracy, sensitivity and specificity of brush cytology of the oral cavity for detection of malignant tumor were calculated as 86.36%, 81.25% and 100% respectively. Whereas accuracy, sensitivity and specificity of brush cytology of the oral cavity for detection of benign and inflammatory conditions were 100%.&#x0D; Conclusion: Oral brush cytology has good accuracy, sensitivity and specificity for detection of oral epithelial lesions and can be useful in early detection of oral cancer as well as other lesions. Moreover, as an easy-to-do, painless and non-invasive procedure, it can be a good screening method for detection of oral lesions.

A Simulation Paradigm for Evaluation of Subtle Liver Lesions at Pediatric CT: Performance and Confidence.

To create and validate a systematic observer performance platform for evaluation of simulated liver lesions at pediatric CT and to test this paradigm to measure the effect of radiation dose reduction on detection performance and reader confidence. Thirty normal pediatric (from patients aged 0-10 years) contrast material-enhanced, de-identified abdominal CT scans obtained from July 1, 2012, through July 1, 2016, were retrospectively collected from the clinical database. The study was exempt from institutional review board approval. Zero to three simulated, low-contrast liver lesions (≤6 mm) were digitally inserted by using software, and noise was added to simulate reductions in volume CT dose index (representing radiation dose estimation) of 25% and 50%. Pediatric, abdominal, and resident radiologists (three of each) reviewed 90 data sets in three sessions using an online interface, marking each lesion location and rating confidence (scale, 0-100). Statistical analysis was performed by using software. Mixed-effects models revealed a significant decrease in detection sensitivity as radiation dose decreased (P < .001). The mean confidence of the full-dose and 25% dose reduction examinations was significantly higher than that of the 50% dose reduction examinations (P = .011 and .012, respectively) but not different from one another (P = .866). Dose was not a significant predictor of time to complete each case, and subspecialty was not a significant predictor of sensitivity or false-positive results. Sensitivity for lesion detection significantly decreased as dose decreased; however, confidence did not change between the full-dose and 25% reduced-dose scans. This suggests that readers are unaware of this decrease in performance, which should be accounted for in clinical dose reduction efforts.Keywords: Abdomen/GI, CT, Liver, Observer Performance, Pediatrics, Perception Image© RSNA, 2019.

Screening and grading of fundus images of diabetic retinopathy based on visual attention

Objective To construct an intelligent analysis system based on visual attention for diabetic retinopathy (DR) assistant diagnosis and to realize the automatic screening and grading of fundus images of DR. Methods Total of 35 126 DR fundus images were downloaded from the Diabetic Retinopathy Detection competition in the Data Modeling and Data Analysis Competition Platform (Kaggle), and 1 200 fundus images were downloaded from the Messidor website.Firstly, according to the characteristics of DR fundus images, a series of preprocessing was carried out for retina images.Then, on the basis of VGG16 network, visual attention SENet module was introduced to improve the saliency of lesion features, and a deep convolution neural network SEVGG with complex network structure was generated.The network basically inherited some structural parameters of VGG16, and the parameters of SENet module were adjusted according to the basic network and training data set.Finally, the SEVGG network model was used to screen the DR fundus image, and the fundus image was divided into different levels according to the degree of lesions of DR in different periods.Configure the training platform and environment and perform algorithm performance verification experiments. Results The method proposed in this study was tested on different open standard datasets, and finally achieved high accuracy in image-based classification.The accuracy of 5 classification in Kaggle dataset was 83%, the sensitivity of lesion detection was 99.86% and the specificity was 99.63%.The accuracy rate of the 4 classification in the Messidor data set was up to 88%, the sensitivity of the lesion detection was 98.17%, and the specificity was 96.39%.The introduction of visual attention was more significant for the focus of the lesion, which helped the accurate detection of DR. Conclusions This method effectively avoids some shortcomings of traditional artificial feature extraction and fundus image classification, and is more accurate for lesion recognition.It is not only superior to the previous method, but also shows better robustness and generalization. Key words: Diabetic retinopathy; Visual attention; Convolutional neural network; Attention module; Grading

Clinical translational application of Raman spectroscopy to advance Benchside biochemical characterization to bedside diagnosis of esophageal diseases.

Esophageal diseases result in significant mortality, morbidity, and health care costs worldwide. Current approaches to detect and monitor esophageal diseases have severe limitations. Advanced imaging technologies are being developed to complement current approaches to improve diagnostic, therapeutic and surveillance protocols in order to advance the field. Raman spectroscopy-based technologies hold promise to increase the sensitivity for detection of diseased and high-risk lesions in vitro and in vivo in real time. This technique allows for the investigation of microstructural changes and also facilitates the discovery of disease-specific biochemical alterations with the potential to provide novel insights into the pathobiology of these conditions. Raman spectroscopy has been increasingly applied in precancerous and cancerous esophageal conditions. However, its application in benign esophageal diseases is still in the early stages. Continuing its application in cancerous and precancerous conditions and expanding its use to benign esophageal disorders could lay a foundation for integration of this technology in clinical practice and diagnostic paradigms and development of an accurate and cost-effective tool for use in a clinical setting. Furthermore, Raman spectroscopy can also be used as an innovative technique to advance our understanding of the biochemical transformations associated with esophageal diseases and answer a myriad of fundamental questions in the field. In this review, we described the principles of Raman spectroscopy and instrumentation while providing an overview of current applications, challenges, and future directions in the context of esophageal diseases with an emphasis on its clinical translational application.

Value of early repeated abdominal CT in selective non-operative management for blunt bowel and mesenteric injury.

To evaluate the performance of an early repeated computed tomography (rCT) in initially non-operated patients with blunt bowel and mesenteric injuries (BBMI). This was a monocentric retrospective observational study from 2009 to 2017 of patients with a BBMI on initial CT (iCT). Patients initially non-operated on were scheduled for a rCT within 48h. Initial CT and rCT diagnostic performance were compared based on a surgical injury prediction score previously described. For statistical analysis, we used the chi-square analyses for paired data (McNemar test). Eighty-four patients (1.9% of trauma) had suspected BBMI on iCT. Among these patients, 22 (26.2%) were initially operated on, 18 (21.4%) were later operated on, and 44 (52.4%) were not operated on. The therapeutic laparotomy rate was 85%. Thirty-four patients initially non-operated on had a rCT. The absolute value of the CT scan score increased for 15 patients (44.1%). The early rCT diagnostic performance, compared with iCT, showed an increase in sensitivity (from 63.6 to 91.7%), in negative predictive value (from 77.4 to 94.7%), and in AUC (from 0.77 to 0.94). In initially non-operated patients with BBMI lesions, the performance of an early rCT improved the sensitivity of lesion detection requiring surgical repair and the security of patient selection for non-operative treatment. • Selective non-operative treatment for hemodynamically stable patients with blunt bowel and/or mesenteric injuries on CT is developing but remains controversial. • An early repeated CT improved the sensitivity of lesion detection requiring surgical repair and the security of patient selection for conservative treatment.

CT and gross pathology are comparable methods for detecting some degenerative sacroiliac joint lesions in dogs.

Degenerative sacroiliac joint disease is a cause of lumbosacral pain in dogs; however, published information on cross-sectional imaging characteristics is limited. Objectives of this retrospective, secondary analysis, methods-comparison study were to test hypotheses that CT lesions reported in humans with degenerative sacroiliac joint disease are also present in dogs, and that CT is comparable to gross pathology for detecting these lesions. Matched CT and gross pathology slice images of 30 sacroiliac joints were retrieved from a previous prospective, canine cadaver study. A veterinary radiologist interpreted randomized CT images for each joint based on previously published CT characteristics of lesions in humans with degenerative sacroiliac joint disease. A veterinary pathologist independently interpreted randomized gross pathology images using the same criteria. All joints had at least one CT lesion consistent with degenerative sacroiliac joint disease. A new CT lesion was also identified and termed "subarticular cleft." The CT and gross pathology methods agreed for detecting joints with subchondral sclerosis, subchondral erosion, and intra-articular ankylosis lesions (P > .05, McNemar's test), but disagreed for detection of joints with subchondral cyst, para-articular ankylosis, and subarticular cleft lesions (P ≤ .05). Using gross pathology as the reference standard, CT had 100% sensitivity for detection of subarticular cleft and subchondral cyst lesions, with 56% and 22% specificity, respectively. Para-articular ankylosis lesions were detected by CT but not by gross pathology. Findings supported the hypothesis that CT lesions reported in humans with degenerative sacroiliac joint disease are also present in dogs, and partially supported the hypothesis that CT is comparable to gross pathology for detecting joints with these lesions.

Longitudinal Characterization of Cortical Lesion Development and Evolution in Multiple Sclerosis with 7.0-T MRI.

Background Cortical lesions develop early in multiple sclerosis (MS) and play a major role in disease progression. MRI at 7.0 T shows high sensitivity for detection of cortical lesions as well as better spatial resolution and signal-to-noise ratio compared with lower field strengths. Purpose To longitudinally characterize (a) the development and evolution of cortical lesions in multiple sclerosis across the cortical width, sulci, and gyri; (b) their relation with white matter lesion accrual; and (c) the contribution of 7.0-T cortical and white matter lesion load and cortical thickness to neurologic disability. Materials and Methods Twenty participants with relapsing-remitting MS and 13 with secondary progressive MS, along with 10 age-matched healthy controls, were prospectively recruited from 2010 to 2016 to acquire, in two imaging sessions (mean interval, 1.5 years), 7.0-T MRI T2*-weighted gradient-echo images (0.33 × 0.33 × 1.0 mm3) for cortical and white matter lesion segmentation and 3.0-T T1-weighted images for cortical surface reconstruction and cortical thickness estimation. Cortical lesions were sampled through the cortex to quantify cortical lesion distribution. The Expanded Disability Status Scale (EDSS) was used to assess neurologic disability. Nonparametric statistics assessed differences between and within groups in MRI metrics of cortical and white matter lesion burden; regression analysis explored associations of disability with MRI metrics. Results Twenty-five of 31 (81%) participants developed new cortical lesions per year (intracortical, 1.3 ± 1.7 vs leukocortical, 0.7 ± 1.9; P = .04), surpassing white matter lesion accrual (cortical, 2.0 ± 2.8 vs white matter, 0.7 ± 0.6; P = .01). In contrast to white matter lesions, cortical lesion accrual was greater in participants with secondary progressive MS than with relapsing-remitting MS (3.6 lesions/year ± 4.2 vs 1.1 lesions/year ± 0.9, respectively; P = .03) and preferentially localized in sulci. Total cortical lesion volume independently predicted baseline EDSS (β = 1.5, P < .001) and EDSS changes at follow-up (β = 0.5, P = .003). Conclusion Cortical lesions predominantly develop intracortically and within sulci, suggesting an inflammatory cerebrospinal fluid-mediated lesion pathogenesis. Cortical lesion accumulation was prominent at 7.0 T and independently predicted neurologic disability progression. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Filippi and Rocca in this issue.

Diagnostic Accuracy of a MR Protocol Acquired with and without Endorectal Coil for Detection of Prostate Cancer: A Multicenter Study

Introduction: The purpose of this study was to compare diagnostic accuracy of a prostate multiparametric magnetic resonance imaging (mpMRI) protocol for detection of prostate cancer between images acquired with and without en-dorectal coil (ERC). Materials: This study was approved by the regional ethics committee. Between 2014 and 2015, 33 patients (median age 51.3 years; range 42.1-77.3 years) who underwent prostate-MRI at 3T scanners at 2 different institutions, acquired with (mpMRI_ERC) and without (mpMRI_PPA) ERC and who received radical prostatectomy, were included in this retrospective study. Two expert readers (R1, R2) attributed a PI-RADS version 2 score for the most suspect (i. e. index) lesion for mpMRI_PPA and mpMRI_ERC. Sensitivity and positive predictive value for detection of index lesions were assessed using 2 × 2 contingency tables. Differences between groups were tested using the McNemar test. Whole-mount histopathology served as reference standard. Results: On a quadrant-basis cumulative sensitivity ranged between 0.61-0.67 and 0.76-0.88 for mpMRI_PPA and mpMRI_ERC protocols, respectively (p > 0.05). Cumulative positive predictive value ranged between 0.80-0.81 and 0.89-0.91 for mpMRI_PPA and mpMRI_ERC protocols, respectively. The differences were not statistically significant for R1 (p = 0.267) or R2 (p = 0.508). Conclusion: Our results suggest that there may be no significant differences for detection of prostate cancer between images acquired with and without an ERC.