Specific Imaging Signs Research Articles

A CT-based radiomics integrated model for discriminating pulmonary cryptococcosis granuloma from lung adenocarcinoma-a diagnostic test.

Chest computed tomography (CT) is a critical tool in the diagnosis of pulmonary cryptococcosis as approximately 30% of normal immunity individuals may not exhibit any significant symptoms or laboratory findings. Pulmonary cryptococcosis granuloma and lung adenocarcinoma can appear similar on noncontrast chest CT. This study evaluates the use of an integrated model that was developed based on radiomic features combined with demographic and radiological features to differentiate pulmonary cryptococcosis nodules from lung adenocarcinomas. Preoperative chest CT images for 215 patients with solid pulmonary nodules with histopathologically confirmed lung adenocarcinoma and cryptococcosis infection were collected from two clinical centers (108 cases in the training set and 107 cases in the test set divided by the different hospitals). Radiomics models were constructed based on nodular lesion volume (LV), 5-mm extended lesion volume (ELV), and perilesion volume (PLV). A demoradiological model was constructed using logistic regression based on demographic information (age, sex) and 12 radiological features (location, number, shape and specific imaging signs). Both models were used to build an integrated model, the performance of which was assessed using the test set. A junior and a senior radiologist evaluated the nodules. Receiver operating characteristic (ROC) curve analysis was conducted, and areas under the curve (AUCs), sensitivity (SEN), and specificity (SPE) of the models were calculated and compared. Among the radiomics models, AUCs of the LV, ELV, and PLV were 0.558, 0.757, and 0.470, respectively. Age, lesion number, and lobular sign were identified as independent discriminative features providing an AUC of 0.77 in the demoradiological model (SEN 0.815, SPE 0.642). The integrated model achieved the highest AUC of 0.801 (SEN 0.759, SPE 0.755), which was significantly higher than that obtained by a junior radiologist (AUC =0.689, P=0.024) but showed no significant difference from that of the senior radiologist (AUC =0.784, P=0.388). An integrated model with radiomics and demoradiological features improves discrimination of cryptococcosis granulomas from solid adenocarcinomas on noncontrast CT. This model may be an effective strategy for machine complementation to discrimination by radiologists, and whole-lung automated recognition methods might dominate in the future.

A CT-based nomogram for differentiating invasive fungal disease of the lung from bacterial pneumonia

BackgroundThere is an annual increase in the incidence of invasive fungal disease (IFD) of the lung worldwide, but it is always a challenge for physicians to make an early diagnosis of IFD of the lung. Computed tomography (CT) may play a certain role in the diagnosis of IFD of the lung, however, there are no specific imaging signs for differentiating IFD of lung from bacterial pneumonia (BP).MethodsA total of 214 patients with IFD of the lung or clinically confirmed BP were retrospectively enrolled from two institutions (171 patients from one institution in the training set and 43 patients from another institution in the test set). The features of thoracic CT images of the 214 patients were analyzed on the picture archiving and communication system by two radiologists, and these CT images were imported into RadCloud to perform radiomics analysis. A clinical model from radiologic analysis, a radiomics model from radiomics analysis and a combined model from integrating radiologic and radiomics analysis were constructed in the training set, and a nomogram based on the combined model was further developed. The area under the ROC curve (AUC) of the receiver operating characteristic (ROC) curve was calculated to assess the diagnostic performance of the three models. Decision curve analysis (DCA) was conducted to evaluate the clinical utility of the three models by estimating the net benefit at a range of threshold probabilities.ResultsThe AUCs of the clinical model for differentiating IFD of lung from BP in the training set and test sets were 0.820 and 0.827. The AUCs of the radiomics model in the training set and test sets were 0.895 and 0.857. The AUCs of the combined model in the training set and test setswere 0.944 and 0.911. The combined model for differentiating IFD of lung from BP obtained the greatest net benefit among the three models by DCA.ConclusionOur proposed nomogram, based on a combined model integrating radiologic and radiomics analysis, has a powerful predictive capability for differentiating IFD from BP. A good clinical outcome could be obtained using our nomogram.

Radiomics of MRI scans enables differentiation of benign from malignant soft tissue sarcoma.

11565 Background: Accounting for >15,000 cases annually, soft tissue sarcomas (STSs) represent a large spectrum of tumors with varying histology and clinical course. However, diagnosis of STSs on MRI is challenging due to its heterogeneous imaging phenotypes, such as surrounding soft tissue edema, vascular lesion characteristics, and specific imaging signs, such as splitting of fat between muscles. The goal of this study was to evaluate the utility of radiomic feature analysis for characterizing subtle heterogeneity patterns on T2-weighted MRI to distinguish benign and malignant STSs. Methods: T2-weighted MRI of N = 176 patients with STS were retrospectively obtained from a single institution. (Table) Tumor regions were manually annotated by a radiologist. The radiomic features included textural features, e.g. gray-level co-occurrence matrix features, which quantify the correlation between textural patterns within annotated regions. Maximum relevance minimum redundancy feature selection was employed to identify top 10 radiomic features that are associated with STS malignancy. Then, the identified features were integrated to generate a radiomic risk score (RRS) via logistic regression on a 10-fold cross validation to differentiate benign and malignant STS. Multivariate analysis and the area under the receiver operating characteristic curve (AUC) were employed to evaluate the association of RRS and clinical parameters, including age, gender, and STS location, with STS malignancy. Results: Multivariate analysis illustrated that age and RRS are independent variables in predicting STS malignancy (p < 0.05). The RRS yielded AUC as 0.76 (confidence interval (CI): 0.69-0.83), age 0.71 (CI: 0.64-0.79) and the combination of the RRS and age 0.84 (CI: 0.78-0.90). Conclusions: The RRS generated by radiomic features was found to be a significant predictor of STS malignancy. Furthermore, RRS could provide complementary information to the clinical parameters in differentiating benign and malignant STSs.[Table: see text]

MRI of Muscular Neoplasms and Tumor-like Lesions: A 2020 World Health Organization Classification-based Systematic Review

Imaging findings of pneumonia are diverse, with frequent overlap between the various infectious etiologies of pneumonia, as well as various other disease conditions, including inflammatory conditions, vasculitis, and malignancy. In the appropriate clinical context, a number of imaging findings and the patterns that they form on imaging may provide clues that enable radiologists and clinicians to narrow the differential diagnostic considerations. Although a definite diagnosis can rarely be provided based on imaging findings alone, the combination of clinical, imaging, and laboratory findings are usually sufficient for accurate diagnosis and management decisions. It is important for radiologists to recognize the wide variety of imaging patterns that occur with different causes of pneumonia, and recognize specific imaging signs of certain infections when present, thereby facilitating diagnosis and optimizing patient care.

Злокачественная аденомиоэпителиома молочной железы: клиническое наблюдение и обзор литературы

Aim ― to describe the case of malignant adenomyoepithelioma of the breast and to review the corresponding literature, as well as to identify the specific mammographic and ultrasound signs of this malignancy. Material and methods. We report the case of breast tumor witсh histologic phenotype transformed from benign fibroadenoma to the borderline phylloid tumor and finally to the malignant adenomyoepithelioma. Results. At final examination the malignant adenomyoepithelioma showed the multi-nodular structure. Each node represented at mammography and ultrasound (US) the solid internal structure, oval shape and smooth contour. In case of suspicious non-calcified lesion found at mammography that has the solid internal structure and round or oval shape at US it is necessary to consider the following conditions during the differential diagnosis: low-grade invasive ductal carcinoma, mucinous, medillary, clear-cells carcinomas, invasive ductal carcinoma with necrosis or hemorrhage, low-grade adenosquamose carcinoma, metaplastic carcinoma, malignant adenomyoepithelioma and papillary carcinoma, as well as the following rare benign tumors: phylloid tumor, tubular adenoma, fat necrosis, intraductal papilloma, adenoma of the nipple, papilloma-related metaplastic tumors, ductal adenoma, sclerosing adenosis, complex screrozing lesion, and hemangioma. Conclusion. We found no specific imaging signs that allowed to identify the adenomyoepithelioma. This makes necessary to consider both benign and malignant adenomyoepithelioma during the differential diagnosis of round or oval shape solid lesion detected in mammography and/or ultrasound.

Imaging Patterns of Pneumonia

Imaging findings of pneumonia are diverse, with frequent overlap between the various infectious etiologies of pneumonia, as well as various other disease conditions, including inflammatory conditions, vasculitis, and malignancy. In the appropriate clinical context, a number of imaging findings and the patterns that they form on imaging may provide clues that enable radiologists and clinicians to narrow the differential diagnostic considerations. Although a definite diagnosis can rarely be provided based on imaging findings alone, the combination of clinical, imaging, and laboratory findings are usually sufficient for accurate diagnosis and management decisions. It is important for radiologists to recognize the wide variety of imaging patterns that occur with different causes of pneumonia, and recognize specific imaging signs of certain infections when present, thereby facilitating diagnosis and optimizing patient care.

Both medial and lateral bucket-handle meniscus tears associated with chronic ACL injury: A rare presentation of triple-PCL sign

BackgroundSeveral types of meniscal tear could be presented in both acute and chronic anterior cruciate ligament injury. The incidence of bucket-handle meniscus tears can be up to 30% of the overall meniscus tears cases. The case of both compartment (medial and lateral) bucket-handle meniscus is rarely occurred.CaseA case of both medial and lateral bucket-handle meniscus tears was reported in a male of 21 years old. The patient also had a chronic anterior cruciate ligament injury. The magnetic resonance imaging also showed a rare presentation of the triple-PCL sign with the sagittal view. Arthroscopic surgery with a meniscus repair and anterior cruciate ligament reconstruction was performed on the patient.ConclusionsSeveral specific imaging signs including triple-PCL sign could be presented in a rare case of both medial and lateral bucket-handle meniscus tears. Recognition of this sign is important to have accurate preoperative diagnosis and proper treatment plan.

Similarities and Differences of Early Pulmonary CT Features of Pneumonia Caused by SARS-CoV-2, SARS-CoV and MERS-CoV: Comparison Based on a Systemic Review

To compare the similarities and differences of early CT manifestations of three types of viral pneumonia induced by SARS-CoV-2 (COVED-19), SARS-CoV (SARS) and MERS-CoV (MERS) using a systemic review.MethodsElectronic database were searched to identify all original articles and case reports presenting chest CT features for adult patients with COVID-19, SARS and MERS pneumonia respectively. Quality of literature and completeness of presented data were evaluated by consensus reached by three radiologists. Vote-counting method was employed to include cases of each group. Data of patients' manifestations in early chest CT including lesion patterns, distribution of lesions and specific imaging signs for the three groups were extracted and recorded. Data were compared and analyzed using SPSS 22.0.ResultsA total of 24 studies were included, composing of 10 studies of COVED-19, 5 studies of MERS and 9 studies of SARS. The included CT exams were 147, 40, and 122 respectively. For the early CT features of the 3 pneumonias, the basic lesion pattern with respect to “mixed ground glass opacity (GGO) and consolidation, GGO mainly, or consolidation mainly” was similar among the 3 groups (χ2 = 7.966, p > 0.05). There were no significant differences on the lesion distribution (χ2= 13.053, p > 0.05) and predominate involvement of the subpleural area of bilateral lower lobes (χ2 = 4.809, p > 0.05) among the 3 groups. The lesions appeared more focal in COVID-19 pneumonia at early phase (χ2= 23.509, p < 0.05). The proportions of crazy-paving pattern (χ2 = 23.037, p < 0.001), organizing pneumonia pattern (p < 0.05) and pleural effusions (p < 0.001) in COVID-19 pneumonia were significantly lower than the other two. Although rarely shown in the early CT findings of all three viral pneumonias, the fibrotic changes were more frequent in SAKS than COVID-19 and MERS (χ2 = 6.275, P<0.05). For other imaging signs, only the MERS pneumonia demonstrated tree-in-buds, cavitation, and its incidence rate of interlobular or intralobular septal thickening presented significantly increased as compared to the other two pneumonia (χ2 = 22.412, p < 0.05). No pneumothorax, pneumomediastinum and lymphadenopathy was present for each group.ConclusionsImaging findings on early stage of these three coronavirus pneumonias showed similar basic lesion patterns, including GGO and consolidation, bilateral distribution, and predominant involvement of the subpleural area and the lower lobes. Early signs of COVID-19 pneumonia showed less severity of inflammation. Early fibrotic changes appeared in SAKS only, MERS had more severe inflammatory changes including cavitation and pleural effusion. The differences may indicate the specific pathophysiological processes for each coronavirus pneumonia.

Imaging in Circulatory Arrest: Lessons to be Learned.

Objective:This study describes the computed tomography (CT) features in patients with cardiac or circulatory arrest.Methods:We retrospectively reviewed the CT of 5 patients (age range – 6–50 years) who had circulatory arrest while undergoing imaging, within a 12 month period in our Trauma and Emergency Centre. The presence or absence of contrast in the right and left chambers of heart, venous and arterial system, contrast density, and layering were assessed.Results:Contrast pooling and layering in superior vena cava, inferior vena cava, and right heart chambers were common (5/5 patients). Left heart chambers and systemic arteries were non-opacified. Reflux of contrast was seen in hepatic veins (4/5), portal vein, and renal veins (2/5 patients). Three patients showed pooling in lumbar and posterior external venous plexus. One patient showed contrast in splenic and superior mesenteric vein and two patients had dense opacification of pelvic veins. All patients had a dismal prognosis and died within 24 h.Conclusion:The absence of left-sided chamber opacification and layering and pooling of dense contrast in the venous system is specific imaging signs of circulatory arrest. These features need to be recognized immediately, scanning terminated, and resuscitation initiated.

Imaging of Congenital Brain Tumors

: Congenital brain tumors are not common in newborns but have specific signs, symptoms, and presentations. These tumors include specific types that occur in newborns and early detection and demonstration of anatomical extension of them play critical role for surgical and medical treatment of them. CT Scan and MRI play an important role for diagnosis and follow up of these patient. In this presentation, various types of congenital brain tumors, their different and specific imaging signs will be shown and characteristic classifications of them for better diagnosis will be demonstrated.

Which management strategy should be chosen for calcified masses of the mitral annulus?†

The recent images published by Akita et al. [1] showing intracardiac calcified masses at the level of the mitral annulus represent a specific stage in the spectrum of an evolving disease. ‘Mitral annulus calcification (MAC) may appear under different forms depending from its evolution stage: mitral annulus calcification; homogeneous calcified mass of the mitral valve; liquefaction necrosis of the mass; with reduction or stability of the mass dimension’ during follow-up [2]. This condition may sometimes alter mitral valve function, provoking a transvalvular gradient or regurgitation by a distortion of the valvular apparatus [3]. However, the presence of calcified mitral annular masses protruding inside the left atrium should not be considered per se as an indication for surgery in the absence of an altered valve function. Surgery should not be recommended for the presence of only calcified masses at the level of the mitral annulus. It is true that pathologies of a different nature may affect the annulus or the nearby tissues. However, several imaging modalities [ultrasound, computed tomography scan and cardiac magnetic resonance (CMR)] may currently help to specify the nature of those calcified masses [2– 4]. Different pathologies, such as soft tissue calcified sarcomas, calcified echinococcoccus cysts, cardiac osteocondromas and cardiac calcified amorphous tumours (CAT), should be included in the differential diagnosis [2]. However, specific imaging signs may help to reach a presumptive diagnosis. Soft tissue sarcomas are usually large and invasive masses with calcifications mostly involving only part of the necrotic tumour [4]. In echinococcal cysts, calcifications are classically peripheral. Primitive osteosarcomas can show massive calcification, but they usually grow rapidly [4]. If liquefaction necrosis occurs in MAC, and this is usually associated with a reduced mass dimension during the follow-up and with a benign prognosis [2, 5]. A cardiac CAT, showing a mass (thrombi, infections or infestations) with a mix of calcifications and inflammatory infiltrates, should also be considered in the differential diagnosis [6]. In conclusion, in patients with MAC, surgery should be indicated by the gradient across the valve or by the grade of regurgitation. In cases without abnormal valve function, conservative management may be effective even with large masses [2]. Multimodality imaging studies would help to specify their nature. Indications for surgery should be carefully weighed, in consideration also of the higher incidence of MAC in patients with clinical or subclinical chronic renal failure, as in the reported case.

Radiological diagnostics of triple negative breast cancer: a review

Background. Triple negative breast cancer has a poor prognosis. Therefore, it is vital to detect this subtype of breast cancer in its early stage. The imaging features of this clinically important subtype of breast cancer are not well known. There have been no published reports about radiological diagnostics of triple negative breast tumour in Lithuania. The purpose of this study was to review the imaging characteristics of triple receptor negative cancers in mammography, ultrasonography and magnetic resonance imaging (MRI). Materials and methods. The published data for the period 2006–2011 concerning the imaging of triple negative breast cancer were analyzed. There were ten retrospective, ten prospective studies and five reviews. Five studies were on mammography imaging, three on both mammography and ultrasonography imaging, and five studies dealt with MR imaging data. Two studies analysed all three diagnostic methods. Results. In mammography, triple negative breast (TRN) cancers often present as a mass and are most frequently round, oval or lobular in shape, less frequently being irregular. TRN tumours aren’t associated with calcifications. Moreover, architectural distortion is not a characteristic feature of triple negative breast cancer. In ultrasonography, TRN cancer appears as a parallel. TRN breast tumours mostly are irregular in shape and have a circumscribed margin. Attenuating posterior echoes and hypervascularity are not their characteristic features. In MR imaging, TRN breast cancer tends to have a lobulated, round or oval mass shape. Rim enhancement is identified in most of TRN tumours. Initially, rapid enhancement with a washout pattern (a sign of malignancy) does not usually apply to triple-negative breast cancers. Conclusions. TRN breast cancer is difficult to diagnose, because usually it has no specific imaging signs typical of breast cancer. In mammography, TRN cancers aren’t associated with microcalcifications. In ultrasonography, attenuating posterior echoes and hypervascularity are not characteristic features of TRN tumours. In MRI, initially rapid enhancement with a washout pattern does not usually apply to triple-negative breast cancers. Keywords: triple negative breast cancer, mammography, ultrasonography, magnetic resonance imaging