Standard Imaging Techniques Research Articles

Comparison of pedicle screw placement accuracy between two types of imaging support (Artis Zeego versus two-dimensional fluoroscopy): a cross-sectional observational study

BackgroundThe pedicle screw system is widely used in spine surgery, and it provides rigid fixation and leads to successful subsequent deformity correction and bony fusion. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. Artis Zeego is an emerging intraoperative imaging technique that can provide conventional two-dimensional fluoroscopic images and rapid three-dimensional fluoroscopic computed tomography reconstruction imaging. The aim of this study is to compare the insertion accuracies of PS placement using Artis Zeego and conventional 2D X-ray fluoroscopy.MethodsIn this study, we retrospectively reviewed the postoperative images of thoracolumbar fusion patients who underwent surgery using pedicle screws between 2013 and 2018. Pedicle screw malplacement was assessed using a four-grade classification by Rao et al. Misplacement rates were compared between pedicle screws assisted with Artis Zeego and two-dimensional fluoroscopy.ResultsA total of 1107 pedicle screws in 153 patients were inserted using Artis Zeego, and 427 pedicle screws in 80 patients were inserted using fluoroscopy. The overall perforation rate was 4.2% (46 perforations of 1106 pedicle screws) in the Artis Zeego group and 7.7% (33 perforations of 427 pedicle screws) in the fluoroscopy group. In the Artis Zeego group, 43 (3.9%) screws were classified as grade 1, and three (0.3%) screws were classified as grade 2. In the fluoroscopy group, 21 (4.9%) screws were classified as grade 1, 10 (2.3%) screws were classified as grade 2, and 2 (0.5%) screws were classified as grade 3. The use of Artis Zeego was associated with a significantly lower screw malplacement rate than was the use of fluoroscopy (p < 0.001).ConclusionsOur results demonstrated that pedicle screw placement with Artis Zeego was associated with a lower malplacement rate than was conventional two-dimensional fluoroscopy. No severe malplacement was observed in the Artis Zeego group. Thus, Artis Zeego could be a good option for improving pedicle screw accuracy.

Structured bone marrow report as an assessment tool in patients with hematopoietic disorders.

There are multiple hematological and other entities (metastases, infections) that can affect the bone marrow (BM). The gold standard imaging technique for BM examination is magnetic resonance imaging (MRI). Technological advances have made it possible to digitalize image files and create applications that help to produce higher quality structured reports, facilitating the analysis of data and unifying the criteria collected, making it possible to fill an existing gap. The aim of this study is to present a structured report model applicable to BM studies by MRI. We have carried out a systematic review following the recommendations of the PRISMA checklist report to explore previous publications applying structured BM MRI reporting. Eligibility criteria: the selection of articles carried out by MeSH thesaurus. Original or review articles of BM pathology assessed by MRI. Our group with a wide experience in the evaluation of BM by MRI have designed a model for BM report using eight items: demographic data, diagnostic suspicion, technical data, type of exam initial or control, distribution and patterns involvement, complications and location, total assessment comments. We have not found articles that reflect the existence of a structured report of BM examination by MRI. Only one descriptive article has been identified on guidelines for acquisition, interpretation and reporting which refers to a single entity. With the selected parameters, a software has been developed that allows to fill in the sections of the structured report with ease and immediacy and to send the result directly to the clinician. Structured reports are the result of applying a logical structure to the radiological report, and the rules of elaboration comprise several criteria: (I) using a uniform language. The standardization of terminology avoids ambiguity in reporting and makes it easier to compare reports. (II) Accurately describe the radiological findings, following a prescribed order with review questions and answers. (III) Drafting using diagnostic screening tables. (IV) Respect the radiologists' workflow by facilitating the work and not hindering it. The final report of this work has been the product of the clinical-radiological collaboration in our working group.

Abstract 5161: Exome-scale longitudinal tracking of emerging therapeutic resistance in GIST via analysis of circulating tumor DNA

Abstract Gastrointestinal stromal tumors (GIST) are lethal tumors characterized by constitutively activating mutations to KIT or PDGFRA. Transient disease control in the first-line setting is achieved via inhibition of tyrosine kinase signaling using the KIT inhibitor imatinib. As patients progress through subsequent lines of therapy a molecularly heterogeneous disease evolves, characterized by distinct subtypes and shifting repertoires of exon-specific KIT variants which directly impact treatment outcomes. Here, we use tumor-informed exome-scale liquid biopsy to identify and track the evolution of multiple resistance mechanisms in patients receiving tyrosine kinase inhibitors (TKIs) to address the unmet need of comprehensive understanding of GIST evolution in response to therapy. Matched tumor, normal and serial plasma samples were obtained from 15 heavily pretreated metastatic GIST patients. Following baseline sample collection, all patients received systemic TKI therapy, and were monitored until disease progression. Exome-scale detection of somatic variants in cfDNA from longitudinal matched plasma samples was achieved using the NeXT Liquid BiopsyTM platform. The ImmunoID NeXT PlatformⓇ, an augmented exome/transcriptome platform and analysis pipeline which generates comprehensive tumor and immune data was used to profile paired tumor and normal samples. Longitudinal whole exome sequencing of plasma identified dynamic shifts in existing clones harboring exon-specific KIT mutations, and evolution of new KIT mutations arising prior to identification of tumor progression using standard imaging techniques. We detected a correlation between the number of damaging mutations detected in baseline ctDNA and tumor exon 11 KIT mutation status, suggesting that plasma mutation profiles may be KIT-variant dependent. ctDNA from patients with shorter overall survival (OS) was enriched for variants in the PI3K-AKT and MAPK pathway, potentially contributing to immune evasion observed in those patients. Additional associations were observed between gene copy-number changes and OS (P = .0097). Previous studies have demonstrated that immune infiltration and activity may be KIT variant specific, here we broaden those findings, identifying a significant correlation between TCRɑ clonality and variants detected only in plasma (P = .04), as well as a significant association between TCRβ diversity and OS (HR = 2.55, log rank P = .04). Comprehensive profiling of paired tumor tissue (WES and RNA-Seq) and WES of serially collected ctDNA sensitively and repeatedly identified evolving KIT mutations and other molecular alterations prior to radiologically confirmed disease progression. These findings suggest plasma-based monitoring of late-stage GIST malignancies may be useful for non-invasive disease tracking, providing treatment guidance prior to traditional approaches. Citation Format: Charles W. Abbott, Niamh Coleman, Jing Wang, Josette Northcott, Jason Pugh, Dan Norton, Fábio C. Navarro, Lee D. McDaniel, Eric Levy, Rachel Marty Pyke, John Lyle, Jason Harris, Gabor Bartha, Filip Janku, John West, Richard O. Chen, Sean Boyle. Exome-scale longitudinal tracking of emerging therapeutic resistance in GIST via analysis of circulating tumor DNA [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5161.

Sequential multiblock partial least squares discriminant analysis for assessing prostate cancer aggressiveness with multiparametric magnetic resonance imaging

In current radiology practice, multi-parametric magnetic resonance imaging (mpMRI) has recently become a key tool in diagnostic and therapeutic decisions. Although it is based on the subjective assessment of T2-weighted images, as well as perfusion-weighted and diffusion-weighted sequences, further quantitative parameters can also be derived from them for improving lesion phenotyping. Despite these parameters are usually exploited in a univariate way, ignoring the benefits of a real multivariate approach, still it is the gold standard imaging technique to assess prostate cancer location and probability of malignancy. In this paper, pharmacokinetic (perfusion) and exponential (diffusion) clinical models, as well as latent variable-based multivariate statistical models like multivariate curve resolution-alternating least squares (MCR-ALS), have been calculated and analyzed with sequential multi block-partial least squares discriminant analysis (SMB-PLS-DA) including technique-block differentiation, in order to better assess for cancer aggressiveness based on Gleason scales. The best prediction result was achieved by the ordered combination of diffusion blocks (MCR-ALS and exponential models) and normalized T2 values. The perfusion blocks did not improve the results obtained by diffusion and T2-weighted based parameters alone, so they can be removed from the SMB-PLS-DA model.

Abstract 269: Coronary Artery Calcium As A Predictor For Stenting Outcomes: A Meta-analytic Comparison

Abstract: Coronary Artery Calcium (CAC) measurement and its usefulness to stratify patients by CAD risk remains an area of controversy. Current AHA/ACC guidelines recommend using CAC to guide management on patients with risk factors for CAD but not on optimal medical treatment. The purpose of this study is to investigate the impact of CAC on stenting outcomes. Methods: A systematic review of MEDLINE using PRISMA guidelines was conducted using the search terms CAC, Calcium, Coronary, and Stent. Studies were included if they had an appropriate control group and subdivided high coronary calcium and low coronary calcium measured using an approved imaging modality. Clinical characteristics of patients and outcomes were aggregated according to the Cochrane Manual. A random effects model was used to retrieve odds ratio values. Revman 5.3 was used to aggregate outcomes. Results: A total of 11 studies with 56,725 patients were included. The high CAC cohort included 14,390 patients and Low/No CAC included 42,335 patients. TLR was significantly higher in the high CAC cohort: Odds Ratio: 1.82 [1.37, 2.43], Test for overall effect: Z = 4.08 (P &lt; 0.0001). Heterogeneity was significant amongst the studies for TLR but not amongst TVR or Stent Thrombosis outcomes (Heterogeneity: Tau 2 = 0.14; Chi 2 = 84.08, df = 10 (P &lt; 0.00001); I 2 = 88%). TVR and Stent Thrombosis was significantly higher in the high CAC cohort: Odds Ratio 1.20 [1.14, 1.26] and Odds Ratio 1.42 [1.24, 1.62] Test for overall effect: Z = 5.01 (P &lt; 0.00001) respectively. Conclusion: TLR, TVR, and Stent Thrombosis were all significantly higher in the high CAC cohort as compared to control. Elevated CAC not only provides a description of coronary plaque morphology but also can be used to predict adverse interventional outcomes. Further prospective studies with standard imaging techniques are needed to eliminate any inter-imaging modality differences in CAC characterization.

Operative Use of Thoracic Ultrasound in Respiratory Medicine: A Clinical Study.

For over 15 years, thoracic ultrasound has been applied in the evaluation of numerous lung diseases, demonstrating a variable diagnostic predictive power compared to traditional imaging techniques such as chest radiography and CT. However, in unselected pulmonary patients, there are no rigorous scientific demonstrations of the complementarity of thoracic ultrasound with traditional and standardized imaging techniques that use radiation. In this study 101 unselected pulmonary patients were evaluated blindly with ultrasound chest examinations during their hospital stay. Other instrumental examinations, carried out during hospitalization, were standard chest radiography, computed tomography (CT), and, when needed, radioisotopic investigation and cardiac catheterization. The operator who performed the ultrasound examinations was unaware of the anamnestic and clinical data of the patients. Diffuse fibrosing disease was detected with a sensitivity, specificity and diagnostic accuracy of 100%, 95% and 97%, respectively. In pleural effusions, ultrasound showed a sensitivity, specificity and diagnostic accuracy of 100%. In consolidations, the sensitivity, specificity and diagnostic accuracy were 83%, 98% and 93%, respectively. Low values of sensitivity were recorded for surface nodulations of less than one centimeter. Isolated subpleural ground glass densities were identified as White Lung with a sensitivity of 72% and a specificity of 86%. Only the associations Diffuse ultrasound findings/Definitive fibrosing disease, Ultrasound Consolidation/Definitive consolidation and non-diffuse ultrasound artefactual features/Definitive vascular pathology (pulmonary hypertension, embolism) were statistically significant with adjusted residuals of 7.9, 7 and 4.1, respectively. The obtained results show how chest ultrasound is an effective complementary diagnostic tool for the pulmonologist. When performed, as a complement to the patient’s physical examination, it can restrict the diagnostic hypothesis in the case of pleural effusion, consolidation and diffuse fibrosing disease of the lung.

The Gemelli Ultrasound Chronic Pancreatitis Score: A Non-invasive Tool for the Diagnosis of Chronic Pancreatitis.

A dedicated ultrasound (US) score, the Gemelli Ultrasound Chronic Pancreatitis (USCP) score, could be useful in the follow-up of patients with chronic pancreatitis (CP). However, its role in the diagnosis of CP has not been investigated. We aimed to evaluate the role of the Gemelli USCP score in the diagnosis of CP and the agreement with standard imaging techniques. Ninety-three patients clinically suspected of having CP and referred to the pancreatic outpatient clinic of A. Gemelli Hospital for endoscopic ultrasound (EUS) were prospectively enrolled. All patients underwent pancreatic US to calculate the Gemelli USCP score. A receiver operating characteristic curve analysis was also performed to assess the performance of the US score in CP diagnosis. The Gemelli USCP score was inversely related to the Rosemont score for both total value (p < 0.0001) and each parameter evaluated (p < 0.0001). This score was significantly higher in patients with CP with an excellent area under the receiver operating characteristic curve (0.946) and the optimal cutoff of 5. Moreover, we found a significant correlation between the Gemelli USCP score and laboratory parameters related to pancreatic exocrine insufficiency (p < 0.0001). The development of a dedicated ultrasound score could be useful as a non-invasive tool in the diagnosis of CP.

Structural Connectivity of Human Inferior Colliculus Subdivisions Using in vivo and post mortem Diffusion MRI Tractography.

Inferior colliculus (IC) is an obligatory station along the ascending auditory pathway that also has a high degree of top-down convergence via efferent pathways, making it a major computational hub. Animal models have attributed critical roles for the IC in in mediating auditory plasticity, egocentric selection, and noise exclusion. IC contains multiple functionally distinct subdivisions. These include a central nucleus that predominantly receives ascending inputs and external and dorsal nuclei that receive more heterogeneous inputs, including descending and multisensory connections. Subdivisions of human IC have been challenging to identify and quantify using standard brain imaging techniques such as MRI, and the connectivity of each of these subnuclei has not been identified in the human brain. In this study, we estimated the connectivity of human IC subdivisions with diffusion MRI (dMRI) tractography, using both anatomical-based seed analysis as well as unsupervised k-means clustering. We demonstrate sensitivity of tractography to overall IC connections in both high resolution post mortem and in vivo datasets. k-Means clustering of the IC streamlines in both the post mortem and in vivo datasets generally segregated streamlines based on their terminus beyond IC, such as brainstem, thalamus, or contralateral IC. Using fine-grained anatomical segmentations of the major IC subdivisions, the post mortem dataset exhibited unique connectivity patterns from each subdivision, including commissural connections through dorsal IC and lateral lemniscal connections to central and external IC. The subdivisions were less distinct in the context of in vivo connectivity, although lateral lemniscal connections were again highest to central and external IC. Overall, the unsupervised and anatomically driven methods provide converging evidence for distinct connectivity profiles for each of the IC subdivisions in both post mortem and in vivo datasets, suggesting that dMRI tractography with high quality data is sensitive to neural pathways involved in auditory processing as well as top-down control of incoming auditory information.

Element differentiation with a Hartmann based X-ray phase imaging system

Significant efforts are currently ongoing in X-ray imaging to provide multimodal imaging systems, targeting better sensitivity and specificity for both biomedical or non-destructive testing (NDT) applications. For example, in mammography, knowing the elemental composition of breast microcalcifications would help to differentiate malign and benign tumours. Standard X-ray Phase Contrast Imaging (XPCI) techniques provide only qualitative information of elements with similar absorption. However, their chemical composition can be determined from the measurement of the phase as it is directly related to the optical index of elemental materials. We will show new experimental results obtained with a novel X-ray phase imaging system based on a Hartmann mask. The system demonstrates capacity to discriminate and quantify the elemental composition. Early data treatment succeeded to retrieve both the real and imaginary parts of the index of refraction.

Imaging arbitrary incoherent source distributions with near quantum-limited resolution

We demonstrate an approach to obtaining near quantum-limited far-field imaging resolution of incoherent sources with arbitrary distributions. Our method assumes no prior knowledge of the source distribution, but rather uses an adaptive approach to imaging via spatial mode demultiplexing that iteratively updates both the form of the spatial imaging modes and the estimate of the source distribution. The optimal imaging modes are determined by minimizing the estimated Cramér-Rao bound over the manifold of all possible sets of orthogonal imaging modes. We have observed through Monte Carlo simulations that the manifold-optimized spatial mode demultiplexing measurement consistently outperforms standard imaging techniques in the accuracy of source reconstructions and comes within a factor of 2 of the absolute quantum limit as set by the quantum Cramér-Rao bound. The adaptive framework presented here allows for a consistent approach to achieving near quantum-limited imaging resolution of arbitrarily distributed sources through spatial mode imaging techniques.

New Radioprotective Device that can be Used for Fluoroscopic Exam: Possibility to Contribute to Staff Exposure Protection During VFSS.

The videofluoroscopic swallowing study (VFSS) is a recognized standard diagnostic imaging technique that is used to investigate swallowing disorders and dysphagia. Patients were assessed in a seated posture on a chair or wheelchair. Using X-ray fluoroscopy, the state of patients' swallowing was checked by eating and drinking according to the physician's instructions. VFSS procedures are prolonged, and VFSS staff members are exposed to radiation. Therefore, we evaluated original lead shielding device (OLSD) that can be attached to the handrail of a table and placed vertically. The OLSD has a lead-equivalent thickness of 0.3 mmPb, weighs about 6kg, and has the dimensions 50cm × 50cm × 8.0mm. We used a human phantom and a radiation survey meter with and without protection from scattered radiation at the positions of the physician and medical staff at the height of 150cm above the floor (i.e., the height of the eye's crystalline lens). After measuring the scattered radiation, we created radiation maps with and without the OLSD. The dose rate at the physician's position without and with the OLSD was 190 µSv/h and 92 µSv/h, respectively, and a dose reduction of 51.6% with the plate. Moreover, the radiation maps added clarity to the distribution of the scattered radiation. Such information should lead to greater awareness about exposures to physicians and other medical staff. Thus, the OLSD effectively provided protection from scattered radiation at the physician's position during fluoroscopy. It may contribute to the reduction of staff exposure for VFSS.

A novel semiautomated method for background activity and biological tumour volume definition to improve standardisation of 18F-FET PET imaging in glioblastoma

BackgroundMulticentre clinical trials evaluating the role of 18F-Fluoroethyl-l-tyrosine (18F-FET) PET as a diagnostic biomarker in glioma management have highlighted a need for standardised methods of data analysis. 18F-FET uptake normalised against background in the contralateral brain is a standard imaging technique to delineate the biological tumour volume (BTV). Quantitative analysis of 18F-FET PET images requires a consistent and robust background activity. Currently, defining background activity involves the manual selection of an arbitrary region of interest, a process that is subject to large variability. This study aims to eliminate methodological errors in background activity definition through the introduction of a semiautomated method for region of interest selection. A new method for background activity definition, involving the semiautomated generation of mirror-image (MI) reference regions, was compared with the current state-of-the-art method, involving manually drawing crescent-shape (gCS) reference regions. The MI and gCS methods were tested by measuring values of background activity and resulting BTV of 18F-FET PET scans of ten patients with recurrent glioblastoma multiforme generated from inputs provided by seven readers. To assess intra-reader variability, each scan was evaluated six times by each reader. Intra- and inter-reader variability in background activity and BTV definition was assessed by means of coefficient of variation.ResultsCompared to the gCS method, the MI method showed significantly lower intra- and inter-reader variability both in background activity and in BTV definition.ConclusionsThe proposed semiautomated MI method minimises intra- and inter-reader variability, providing a valuable approach for standardisation of 18F-FET PET quantitative parameters.Trial registration ANZCTR, ACTRN12618001346268. Registered 9 August 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374253

CT study protocol optimization in acute non-traumatic abdominal settings.

Abdominal acute pain is a manifestation of heterogeneous medical conditions, with difficult clinical-laboratory assessment. Multi-detector CT (MDCT) is the gold standard imaging technique for evaluating adult patients with acute abdominal pain. Due to its fast execution and the high spatial resolution, CT is fundamental in the diagnostic and therapeutic work-up of patients with time-dependent pathology that could require surgical treatment, reducing mortality and morbidity. However, the radiological risk connected to the ionizing radiation use should not be underestimated, especially in young patients. The aim of this study is to identify optimized CT protocols to apply in the management of non-traumatic acute abdomen. In particular, this review is focused on the main emergency settings: acute pancreatitis, small bowel obstruction, acute appendicitis and acute diverticulitis. This survey would not be complete without mentioning Dual-Energy CT (DECT) technique, one of the last frontiers in CT, achieving encouraging results also in acute abdominal conditions.

A Corresponding Point Measurement System Provides Reliable Measurement of Displacement for Medial Epicondyle Fractures.

Ten fellowship-trained pediatric orthopaedic surgeons assessed fracture displacement in 6 patients with displaced medial epicondyle fractures using radiographic views (anteroposterior, lateral, axial, internal oblique [IO], and external oblique [EO]) and computed tomographic (CT) views (axial, 3-dimensional [3D] horizontal, and 3D vertical). Raters used a corresponding point method for measuring displacement. For each image, raters measured the absolute displacement, categorized the percent of displacement relative to the size of the fragment and fracture bed, and indicated a treatment option. Interobserver reliability was calculated for each view. Bland-Altman plots were constructed to evaluate the bias between each radiograph and the mean of the CT methods. For absolute displacement, anteroposterior and EO views showed almost perfect interobserver reliability, with an interclass correlation coefficient (ICC) of 0.944 for the anteroposterior view and an ICC of 0.975 for the EO view. The axial view showed substantial reliability (ICC = 0.775). For the displacement category, almost perfect reliability was shown for the anteroposterior view (ICC = 0.821), the axial view (ICC = 0.911), the EO view (ICC = 0.869), and the IO view (ICC = 0.871). Displacement measurements from the anteroposterior, axial, and EO views corresponded to the measurements from the CT views with a mean bias of <1 mm for each view. However, the upper and lower limits of agreement were >5 mm for all views, indicating a substantial discrepancy between radiographic and CT assessments. Treatment recommendations based on CT changed relative to the recommendation made using the anteroposterior view 29% of the time, the EO view 41% of the time, and the axial view 47% of the time. Using a corresponding point measurement system, surgeons can reliably measure and categorize fracture displacement using anteroposterior, EO, and axial radiographic views. CT-based measurements are also reliable. However, although the mean difference between the radiograph-based measurements and the CT-based measurements was only about 1 mm, the discrepancy between radiographic views and CT-based methods could be as large as 5 to 6 mm. Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Three-dimensional printing, holograms, computational modelling, and artificial intelligence for adult congenital heart disease care: an exciting future.

Congenital heart disease (CHD) is often comprised of complex three-dimensional (3D) anatomy that must be well understood to assess the pathophysiological consequences and guide therapy. Thus, detailed cardiac imaging for early detection and planning of interventional and/or surgical treatment is paramount. Advanced technologies have revolutionized diagnostic and therapeutic practice in CHD, thus playing an increasing role in its management. Traditional reliance on standard imaging modalities including echocardiography, cardiac computed tomography (CT) and magnetic resonance imaging (MRI) has been augmented by the use of recent technologies such as 3D printing, virtual reality, augmented reality, computational modelling, and artificial intelligence because of insufficient information available with these standard imaging techniques. This has created potential opportunities of incorporating these technologies into routine clinical practice to achieve the best outcomes through delivery of personalized medicine. In this review, we provide an overview of these evolving technologies and a new approach enabling physicians to better understand their real-world application in adult CHD as a prelude to clinical workflow implementation.

Central Nervous System Tumors in Children.

Central Nervous System Tumors in Children.

Correlation of Sonourethrography Findings of Male Anterior Urethral Stricture with Retrograde Urethrography

Introduction: Imaging plays significant role in diagnosing the male urethral stricture and helps the urologist in determining the treatment protocols. Retrograde urethrography (RGU) had been the standard imaging technique for anterior urethral stricture. Sonourethrography (SUG) as compared to the retrograde urethrography has the advantage of being radiation free. Aim of this study was to compare the sonourethrography findings in anterior urethral stricture with that of retrograde urethrography. Methods: This was an observational study done in 46 patients with clinical symptoms related to lower urinary tract during the period of September 2019 to August 2020 after obtaining informed consent. Ethical clearance was received from Institutional Review Committee, Institute of Medicine. Patients were first evaluated by sonourethrography. Then, retrograde urethrography was done as per the standard protocol of the department. Data were collected in the predesignated proforma including the study variables on sonourethrography and retrograde urethrography and entered in IBM SPSS version 20. The lengths of strictures on sonourethrography and retrograde urethrography were compared. Results: Among 46 patients 21 patients showed anterior urethral strictures on both SUG and RGU with bulbar region as the commonest location. SUG showed all the urethral strictures seen on RGU with significant positive correlation. SUG also showed spongiofibrosis in nine patients. Conclusion: Sonourethrography, an radiation free imaging technique, showed all the strictures seen in retrograde urethrography with added benefit of detection of spongiofibrosis as well.

Diagnosis of Brain Tumor Using Artificial Neural Network

Accurate detection and diagnosis of brain tumor is one the crucial task of medical image analysis. Brain tumor classification system aids the physician to make accurate diagnosis and to provide effective treatment. Magnetic Resonance Imaging (MRI) is the gold standard imaging technique for brain tumor diagnosis. This paper proposes a method for brain tumor detection and classification using artificial neural network. The proposed method consists of four major processes such as preprocessing, region of interest segmentation, feature extraction and classification. Feed forward neural network is employed to classify the brain tumors. Classification performance of the proposed method is evaluated using 10-cross fold validation and compared with the previous methods. Empirical findings proved that the proposed method can efficiently classify the brain tumor with higher classification rate.

Advances in the Noninvasive Diagnosis of Dry Eye Disease

Dry eye disease (DED) is a multifactorial disease that represents one of the most common ophthalmologic conditions encountered in everyday clinical practice. Traditional diagnostic tests for DED, such as subjective questionnaires, tear film break-up time and the Schirmer test, are often associated with poor reproducibility and reliability, which make the diagnosis, follow-up, and management of the disease challenging. New advances in imaging technologies enable objective and reproducible measurements of DED parameters, thus making the diagnosis a multimodal imaging-based process. The aim of this review is to summarize all the current and emerging diagnostic tools available for the diagnosis and monitoring of DED, such as non-invasive tear breakup time, thermography, anterior segment optical coherence tomography, meibography, interferometry, in vivo confocal microscopy, and optical quality assessment. Although there is not a gold standard imaging technique, new multi-imaging-integrated devices are precious instruments to help clinicians to better cope with the diagnostic complexity of DED.

MRI-Derived Radiomics of Hemophilic Arthropathy Is Associated with Severity of Joint Disease

IntroductionJoint bleeding resulting in synovial hypertrophy and articular cartilage damage are the hallmarks of hemophilic arthropathy. Early prophylaxis with extended half-life factor products and non-factor replacement therapies reduce joint bleeds but do not provide complete protection from development of arthropathy. MRI is the gold standard imaging technique to diagnose and monitor arthropathy in hemophilia. MRI changes that are associated with joint bleeding and development of arthropathy, however, are not sensitive enough to detect early changes in the synovial membranes after sub-clinical bleeding. Radiomics, the computerized extraction of sub-visual attributes from imaging scans can detect early changes of hemophilic arthropathy and help in more accurate characterizations of severe joint disease. The goal of this project was to develop and compare MRI radiomics with the International Prophylaxis Study Group (IPSG) score, an established MRI joint disease scale, in assessing the severity of joint disease.MethodsAfter IRB approval, knee MRI scans of 17 hemophilia patients with a history of joint bleeding and 12 age-matched healthy controls were included in this study. Manual annotations were performed in consensus by a board-certified musculoskeletal radiologist to include the prefemoral fat, suprapatellar fat pad and bursa . To ensure that the signal intensities from different cases were in tissue-specific correspondence, a landmark-based histogram transformation was used to align MRI signal intensity distributions across all cases. 560 radiomic features capturing MRI pixels texture heterogeneity (Gabor wavelets, Laws texture, Haralick and GoLIAGe co-occurrence patterns) were subsequently extracted on all MRI slices with ROI for all the cases. Top 2 radiomic features (F 2) for differentiating between abnormal joint changes and control were selected by Minimum Redundancy Maximum Relevance (mRMR) algorithm with 100 iterations of 3-fold cross-validation. Consensus hierarchical clustering was then applied on F 2, from which two patient clusters were generated. A disease severity score was calculated based on historical lifetime bleed events in the joint, designation of target joint status, and history of surgical synovectomy. A previously described 17-point MRI IPSG score was also calculated by 2 independent reviewers. Both the IPSG score and the F 2 were then fit into a linear regression model separately as predictors whereas the disease severity score was set to be the response variable. The Akaike's Information Criteria (AIC) and the root mean square error (RMSE) were used to evaluate the model fitness and the likelihood ratio (LR) test was applied for model comparison.ResultsThe dataset consisted of 17 males with moderate and severe hemophilia ranging in age from 10-55 years. The median disease severity score was 2 (0-11) and the median IPSG MRI Score was 2 (0-11). The top 2 radiomic features F 2, a Gabor wavelet feature and a Lawshc texture feature, yielded an AUC of 0.94 and an accuracy of 0.9 for differentiating between hemophilic joint changes and healthy control patients. Unsupervised clustering demonstrated good separation between the two classes (Fig panel A and B). The radiomic-based linear regression model (AIC: 86.67; RMSE: 2.86) was significantly better than the IPSG score-based model (AIC: 94.24; RMSE: 3.66) in joint disease severity characterizations (LR, p = 0.0083, Fig panel C).ConclusionsRadiomic analysis of knee MRI in hemophilia patients with history of joint bleeding is correlated with the severity of joint disease. Our study demonstrates the feasibility of developing and utilizing a radiomics based tool to detect the severity of joint damage in a small population of knee joint hemophilic arthropathy. We plan to perform an Independent validation of the radiomics signature in a larger dataset of hemophilia joint MRI scans [Display omitted] DisclosuresMadabhushi: Astrazeneca: Membership on an entity's Board of Directors or advisory committees; Bristol Meyers-Squibb: Membership on an entity's Board of Directors or advisory committees; Merck: Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy; Caris: Consultancy; Aiforia: Consultancy; Philips: Research Funding; AstraZeneca: Research Funding; Boehringer-Ingelheim: Research Funding; Bristol Meyers-Squibb: Research Funding. Ahuja: Sanofi: Membership on an entity's Board of Directors or advisory committees; XaTek, Inc: Patents & Royalties; Genentech: Membership on an entity's Board of Directors or advisory committees; Takeda: Other: DSMB member .