Visible Lesions Research Articles

The Depth Estimation and Visualization of Dermatological Lesions: Development and Usability Study.

Thus far, considerable research has been focused on classifying a lesion as benign or malignant. However, there is a requirement for quick depth estimation of a lesion for the accurate clinical staging of the lesion. The lesion could be malignant and quickly grow beneath the skin. While biopsy slides provide clear information on lesion depth, it is an emerging domain to find quick and noninvasive methods to estimate depth, particularly based on 2D images. This study proposes a novel methodology for the depth estimation and visualization of skin lesions. Current diagnostic methods are approximate in determining how much a lesion may have proliferated within the skin. Using color gradients and depth maps, this method will give us a definite estimate and visualization procedure for lesions and other skin issues. We aim to generate 3D holograms of the lesion depth such that dermatologists can better diagnose melanoma. We started by performing classification using a convolutional neural network (CNN), followed by using explainable artificial intelligence to localize the image features responsible for the CNN output. We used the gradient class activation map approach to perform localization of the lesion from the rest of the image. We applied computer graphics for depth estimation and developing the 3D structure of the lesion. We used the depth from defocus method for depth estimation from single images and Gabor filters for volumetric representation of the depth map. Our novel method, called red spot analysis, measures the degree of infection based on how a conical hologram is constructed. We collaborated with a dermatologist to analyze the 3D hologram output and received feedback on how this method can be introduced to clinical implementation. The neural model plus the explainable artificial intelligence algorithm achieved an accuracy of 86% in classifying the lesions correctly as benign or malignant. For the entire pipeline, we mapped the benign and malignant cases to their conical representations. We received exceedingly positive feedback while pitching this idea at the King Edward Memorial Institute in India. Dermatologists considered this a potentially useful tool in the depth estimation of lesions. We received a number of ideas for evaluating the technique before it can be introduced to the clinical scene. When we map the CNN outputs (benign or malignant) to the corresponding hologram, we observe that a malignant lesion has a higher concentration of red spots (infection) in the upper and deeper portions of the skin, and that the malignant cases have deeper conical sections when compared with the benign cases. This proves that the qualitative results map with the initial classification performed by the neural model. The positive feedback provided by the dermatologist suggests that the qualitative conclusion of the method is sufficient.

Patients’ Acceptance of Psoriasis Depends on Disease Severity, Itch Intensity, and the Patients’ Quality of Life: A Cross-Sectional Study

Background/Objectives: Psoriasis is a chronic skin disorder affecting over 60 million people worldwide, with both physical and psychological impacts due to the visible lesions and associated somatic symptoms. This study aimed to assess disease acceptance among psoriasis patients and to explore its correlation with disease severity, itch intensity, and quality of life (QoL) Methods: The study included 166 psoriasis patients, comprising 101 men and 65 women, all with a disease duration of at least one year. Clinical and psychological aspects of psoriasis were comprehensively assessed using various standardized tools, along with a demographic questionnaire. Results: The study found that psoriasis patients had a mean illness acceptance score of 25.1 points, with most respondents (44%) exhibiting a moderate level of acceptance. A high level of acceptance was observed in 28% of participants, while an equal proportion of patients (28%) demonstrating low acceptance, with no significant gender-based differences. Acceptance was negatively correlated with disease severity (PASI score), quality of life impairment (DLQI), and itch intensity (NRS), indicating that lower acceptance was linked to more severe symptoms. Additionally, a slight negative correlation was observed between acceptance and disease duration, while acceptance levels were unaffected by factors such as education, relationship status, or age of disease onset. Conclusions: A comprehensive approach to psoriasis treatment should address not only the physical aspects but also the psychological challenges faced by patients, with a particular focus on improving disease acceptance as a coping strategy. Reducing itch intensity may contribute to better disease acceptance.

Diffusion equation quantification: selective enhancement algorithm for bone metastasis lesions in CT images

Objective.Diffusion equation (DE) imaging processing is promising to enhance images showing lesions of bone metastasis (LBM). The Perona-Malik diffusion (PMD) model, which has been widely used and studied, is an anisotropic diffusion processing method to denoise or extract objects from an image effectively. However, the smoothing characteristics of PMD or its related method hinder extraction and enhancement of soft tissue regions of medical image such as computed tomography (CT), typically leaving an indistinct region with ambient tissues. Moreover, PMD expands the border region of the objects. A novel diffusion methodology must be used to enhance the LBM region effectively.Approach.For this study, we originally developed a DE quantification (DEQ) method that uses a filter function to selectively provide modulated diffusion according to the original locations of objects in an image. The structural similarity index measure (SSIM) and Lie derivative image analysisL-value map were used to evaluate image quality and processing.Main results.We determined superellipse function with its ordern=4as a better performing filter for the LBM region. DEQ was found to be more effective at contrasting LBM for various LBM CT images than PMD or its improved models when the filter was a positive exponential similar function. DEQ yields enhancement agreeing with the indications of positron emission tomography despite complex LBM comprising osteoblastic, osteoclastic, mixed tissues, and metal artifacts, which is innovative. Moreover, DEQ retained high quality of image (SSIM> 0.95), and achieved a low mean value of theL-value (<0.001), indicative of our intended selective diffusion compared to other PMD models.Significance.Our method improved the visibility of mixed tissue lesions, which can assist computer visional framework and can help radiologists to produce accurate diagnose of LBM regions which are frequently overlooked in radiology findings because of the various degrees of visibility in CT images.

Case Report: Surgical treatment of type B aortic dissection in an adult with double aortic arch

BackgroundDouble aortic arch (DAA) with type B aortic dissection in adults is a rare aortic vascular disease. The abnormal anatomical structure of the aortic arch in such patients presents significant challenges in the selection of surgical approaches, and there is a notable lack of exploration into endovascular repair approaches that simultaneously preserve asymptomatic vascular rings.Case descriptionA 43-year-old female patient was admitted due to recurrent chest and back pain lasting for over a month. Computed tomography angiography (CTA) indicated a double aortic arch anomaly with localized dissection of the descending aorta. Esophagography with barium swallow revealed vascular indentation on the upper and middle thoracic esophagus, with mild to moderate local narrowing. Based on a comprehensive preoperative evaluation of the imaging and the patient's clinical history, a thoracic endovascular aortic repair (TEVAR) procedure was performed. Considering that the deformity did not cause any clinical symptoms and that the vessel diameter and distance from the proximal anchoring area were sufficient, the posterior section of the dominant arch was chosen as the proximal anchorage zone, and a stent with proximal bare zone was deployed to maintain blood flow to the distal non-dominant arch and preserve the integrity of the vascular ring. Follow-up CTA scans at one- and six-month post-operation showed that the aortic stent was well-positioned, with no visible primary lesion. The patient reported complete resolution of chest pain and no difficulties with swallowing or breathing.ConclusionIn adult patients with DAA complicated by aortic dissection, the abnormal anatomy of the aortic arch poses significant challenges in making treatment decisions. After a comprehensive, multidimensional evaluation of the patient's medical history, CTA, and esophagography, we successfully performed TEVAR procedure. This case provides new insights into the surgical strategy for treating such rare conditions.

A Pilot Study of PSMA PET/CT and MRI Fusion for Prostate Cancer: Software to Replace PET/MRI Hardware.

Introduction: Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT), in combination with magnetic resonance imaging (MRI), may enhance the diagnosis and staging of prostate cancer. Image fusion of separately acquired PET/CT and MRI images serve to facilitate clinical integration and treatment planning. This study aimed to investigate different PSMA PET/CT and MRI image fusion workflows for prostate cancer visualisation. Methods: Eighteen patients with prostate cancer who underwent PSMA PET/CT and MRI prior to radical prostatectomy were retrospectively selected. Alignment of the prostate was performed between PET/CT and MRI via three techniques: semi-automatic rigid, automatic rigid, and automatic non-rigid. Image fusion accuracy was evaluated through boundary and volume agreement, quantified by the Dice Similarity Coefficient (DSC), 95% Hausdorff Distance (HD), and Mean Surface Distance (MSD), with comparison against reconstructed histopathology slices. Results: Image fusion using all techniques resulted in clear lesion visualisation from PSMA PET/CT overlay and anatomical detail afforded by the MRI base and was consistent with histopathology tumour location. Image fusion accuracy was within the recommended range based on a DSC of 0.8-0.9. The automatic non-rigid registration method had the highest volume agreement (DSC: 0.96 ± <0.01) and boundary agreement (HD: 1.17 ± 0.35 mm) when compared to automatic rigid (DSC 0.88 ± 0.02, HD 3.18 ± 0.29 mm) and semi-automatic rigid (DSC 0.80 ± 0.06, HD 5.25 ± 1.68 mm). Conclusions: Image fusion of clinically obtained PET/CT and MRI is feasible and clinically acceptable for use in prostate cancer diagnosis and surgical management. While the best accuracy was observed with the automatic non-rigid technique, which requires further validation, image fusion with clinically accessible methods (semi-automatic rigid) may currently aid patient education, pre-operative planning, and intra-operative guidance.

Mental Health Implications of Acne Vulgaris

Acne vulgaris, a prevalent chronic inflammatory skin condition, affects approximately 9.4% of the global population, with implications that extend beyond physical appearance to significantly impact mental health. While acne primarily manifests through visible skin lesions, such as comedones, papules, and pustules, the condition’s psychological toll can be profound. Many individuals with acne experience elevated levels of anxiety, depression, and reduced self-esteem, especially adolescents, for whom acne can disrupt self-identity formation. These mental health challenges are often exacerbated by the social stigma associated with visible skin conditions, leading to issues like social withdrawal, body image concerns, and, in severe cases, even suicidal thoughts. Effectively managing acne requires a holistic approach that addresses both physical symptoms and psychological well-being. Dermatological treatments, including topical retinoids, benzoyl peroxide, and oral isotretinoin, are commonly used to control acne symptoms. Dietary modifications, such as reducing high-glycemic foods and dairy, and the use of probiotics, have shown promise as supportive measures. However, addressing the psychological component is equally critical; integrating psychological interventions, such as counseling, cognitive-behavioral therapy, and patient education, can help alleviate the mental strain associated with acne, improve adherence to treatment, and enhance quality of life. Further research is essential to explore the long-term benefits of combined dermatological and psychological treatments and to develop personalized approaches that consider individual psychological profiles. A comprehensive treatment model that incorporates both physical and mental health support offers the potential for improved outcomes, fostering both dermatological recovery and mental resilience in individuals affected by acne vulgaris.

Multiple b value diffusion-weighted MRI of liver: A novel respiratory frequency-modulated continuous-wave radar-trigger technique and comparison with free-breathing technique.

The aim of this study was to evaluate a novel respiratory frequency-modulated continuous-wave radar-trigger (FT) technique for multiple -b-value diffusion-weighted imaging (DWI) of liver and compare it with conventional free breathing (FB) DWI technique. 39 patients with focal liver lesions underwent both frequency-modulated continuous-wave radar-trigger (FT) and conventional free-breathing (FB) multi-b-value diffusion-weighted imaging (DWI,b = 0,50,400,800 s/mm2). Two abdominal radiologists independently assessed the quality of liver DWI images obtained using both techniques, measured and compared liver signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at different b-values, as well as apparent diffusion coefficient (ADC) values calculated from all b-values. In terms of image quality, the FT technique is superior to the conventional FB technique, with overall image quality scores (Reader 1, 3.56 ± 0.50 and Reader 2, 3.59 ± 0.55)vs (Reader 1, 2.90 ± 0.75 and Reader 2, 2.97 ± 0.71), respectively. The liver SNR (at b-values of 50,400,and 800) obtained by FT was (138.5 ± 43.48, 96.67 ± 31.95, 71.54 ± 22.03), respectively, which was significantly higher than that obtained by conventional FB (110.90 ± 39.28, 80.86 ± 29.13, 60.43 ± 18.61, P < 0.05). The lesion CNR with FT was significantly higher than that with conventional FB (258.99 ± 151.38 vs 174.60 ± 99.90; 164.56 ± 87.25 vs 111.12 ± 42.43; 118.83 ± 68.76 vs 76.01 ± 35.48, P < 0.001). There was no significant difference in ADC values of liver and lesions between the two techniques: ADCliver-L and ADCliver-R: (FT 1479.3 ± 270.0 vs FB 1529.3 ± 275.5 and FT 1219.6 ± 127.4 vs FB 1248.7 ± 168.2, P > 0.05); ADC lesion:FT(969.0 ± 261.3) vs FB (1017.5 ± 240.4, P > 0.05). For multi-b-value liver diffusion-weighted imaging, FT technique has higher image quality and better lesion visibility than conventional FB technique and there is no significant difference in ADC values of liver and lesions between the two techniques.

Early rectal neoplasm in dual-layer spectral detector computed tomography: dual-layer spectral computed tomography (CT) images improve tumor detection and staging.

Early rectal neoplasms can be treated endoscopically with good prognosis, yet usually present with unspecific or an absence of signs and symptoms and are detected largely by invasive endoscopy with less compliance to screening. The purpose of this cross-sectional study was to explore the diagnostic value of dual-layer spectral detector computed tomography (DSCT) imaging for early rectal neoplasm. Patients who underwent DSCT for evaluation of rectal lesion or routine examination between September 2022 to September 2023 at West China Hospital were prospectively included and identified as group A (control, n=76), group B (rectal advanced adenomas and ≤T1 rectal cancer, n=59), and group C (≥T2 staging rectal cancer, n=74). Lesion visualization was graded to assess image quality. Spectral quantitative measurement, such as Hounsfield unit (HU)40 keV, HU70 keV, iodine concentration (IC), effective atomic number (Zeff), and the slope of spectral curve (λ), was analyzed and compared. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic efficacy of spectral parameters. A comparison of ROC curves was applied to test the significance of differences between the area under the curves (AUCs). Compared to poly-energetic images (PEIs), the multiple parameters from DSCT were of greater capability to recognize rectal lesions. There were significant differences in HU40 keV (208.01±43.60 vs. 255.53±45.16), HU70 keV (87.06±18.55 vs. 100.78±18.26), IC [1.91 (1.71, 2.28) vs. 2.58±0.49], Zeff [8.33 (8.25, 8.50) vs. 8.61±0.20], and λ [3.80 (3.41, 4.52) vs. 5.16±1.00] between the early neoplastic lesions in rectum and the advanced rectal cancer (P<0.001). Significant correlations were found between the DSCT parameters and tumor staging (P<0.001). Furthermore, the AUCs of IC, Zeff, λ, and HUPEI were all above 0.90 for early rectal neoplasm detection, with additional capability of discriminating early rectal neoplasm from advanced rectal cancer. DSCT improved tumor conspicuity and the detection of the early rectal neoplastic lesion, suggesting that it is a promising screening tool in clinical practice.

Delving Into Stem Canker Disease of Potato Caused by Paramyrothecium roridum: A Morphological and Host Range Study in Iran.

In the summer of 2019, a severe stem canker disease affected potato (Solanum tuberosum) plants in a 10-hectare commercial field in Kermanshah province, Iran. Approximately 10% of the plants exhibited wilting, leaf yellowing and brown stem lesions with black sporodochia. Infected plants produced small tubers with no visible lesions. Ten fungal isolates from diseased plants were identified as Paramyrothecium roridum based on colony culture, microscopic characteristics, and analysis of the internal transcribed spacer (ITS) region and part of the β-tubulin gene. The pathogenicity of P. roridum on seedlings was confirmed by fulfilling Koch's postulates. Host range studies revealed a broad pathogenicity of the P. roridum isolate, successfully infecting various plant species with varying disease severities. Cucumis melo (melon) and Nicotiana rustica (wild tobacco) displayed susceptibility, while Triticum aestivum (wheat) and Avena sativa (oat) from the Poaceae family exhibited resistance. This study identifies P. roridum as a novel cause of potato stem canker disease in Iran.

Development of a deep learning method to identify acute ischaemic stroke lesions on brain CT

BackgroundCT is commonly used to image patients with ischaemic stroke but radiologist interpretation may be delayed. Machine learning techniques can provide rapid automated CT assessment but are usually developed from...

Image-Guided Radiation Therapy Is Equally Effective for Basal and Squamous Cell Carcinoma.

Non-melanoma skin cancers (NMSCs), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are highly prevalent and a significant cause of morbidity. Image-guided superficial radiation therapy (IGSRT) uses integrated high-resolution dermal ultrasound to improve lesion visualization, but it is unknown whether efficacy varies by histology. This large retrospective cohort study was conducted to determine the effect of tumor histology on freedom from recurrence in 20,069 biopsy-proven NMSC lesions treated with IGSRT, including 9928 BCCs (49.5%), 5294 SCCs (26.4%), 4648 SCCIS cases (23.2%), and 199 lesions with ≥2 NMSCs (1.0%). Freedom from recurrence at 2, 4, and 6 years was 99.60%, 99.45%, and 99.45% in BCC; 99.58%, 99.49%, and 99.49% in SCC; and 99.96%, 99.80%, and 99.80% in SCCIS. Freedom from recurrence at 2, 4, and 6 years following IGSRT did not differ significantly comparing BCC vs. non-BCC or SCC vs. non-SCC but were slightly lower among SCCIS vs. non-SCCIS (p = 0.002). There were no significant differences in freedom from recurrence when stratifying lesions by histologic subtype. This study demonstrates that there is no significant effect of histology on freedom from recurrence in IGSRT-treated NMSC except in SCCIS. These findings support IGSRT as a first-line therapeutic option for NMSC regardless of histology.

Cervical OCT image classification using contrastive masked autoencoders with Swin Transformer

Background and Objective:Cervical cancer poses a major health threat to women globally. Optical coherence tomography (OCT) imaging has recently shown promise for non-invasive cervical lesion diagnosis. However, obtaining high-quality labeled cervical OCT images is challenging and time-consuming as they must correspond precisely with pathological results. The scarcity of such high-quality labeled data hinders the application of supervised deep-learning models in practical clinical settings. This study addresses the above challenge by proposing CMSwin, a novel self-supervised learning (SSL) framework combining masked image modeling (MIM) with contrastive learning based on the Swin-Transformer architecture to utilize abundant unlabeled cervical OCT images. Methods:In this contrastive-MIM framework, mixed image encoding is combined with a latent contextual regressor to solve the inconsistency problem between pre-training and fine-tuning and separate the encoder’s feature extraction task from the decoder’s reconstruction task, allowing the encoder to extract better image representations. Besides, contrastive losses at the patch and image levels are elaborately designed to leverage massive unlabeled data. Results:We validated the superiority of CMSwin over the state-of-the-art SSL approaches with five-fold cross-validation on an OCT image dataset containing 1,452 patients from a multi-center clinical study in China, plus two external validation sets from top-ranked Chinese hospitals: the Huaxi dataset from the West China Hospital of Sichuan University and the Xiangya dataset from the Xiangya Second Hospital of Central South University. A human-machine comparison experiment on the Huaxi and Xiangya datasets for volume-level binary classification also indicates that CMSwin can match or exceed the average level of four skilled medical experts, especially in identifying high-risk cervical lesions. Conclusion:Our work has great potential to assist gynecologists in intelligently interpreting cervical OCT images in clinical settings. Additionally, the integrated GradCAM module of CMSwin enables cervical lesion visualization and interpretation, providing good interpretability for gynecologists to diagnose cervical diseases efficiently.

Efficacy of Autofluorescence in Detection of Tobacco-associated Oral Mucosal Lesions - A Systematic Review

Abstract Background: This study was conducted with the aim to systematically review the efficacy of autofluorescence in the detection of tobacco-associated oral mucosal lesions. Objectives and Data Sources: Clinical studies with patients that focused on the autofluorescence method in the detection, visualisation, or management of tobacco-associated oral mucosal lesions were included in the literature search across bibliographic databases. Results: Autofluorescence visualisation showed positive results, with high sensitivity scores when compared with the gold standard of histopathology in the clinical evaluation of common tobacco-associated oral mucosal lesions. However, the low specificity values indicate its limited ability to distinguish between dysplasia and other benign conditions. Conclusions and Implications: This review provides promising evidence for the application of autofluorescence in the detection of tobacco-associated oral mucosal lesions where autofluorescence is used in conjunction with conventional examination with the gold standard of histopathological examination. Registration number: PROSPERO 2023 CRD42023442292.

A Comprehensive Systematic Review of Depression and Anxiety in Adults with Pyoderma Gangrenosum

Background: Pyoderma gangrenosum (PG) is a rare, chronic inflammatory skin disease characterized by painful, necrotic ulcers that frequently lead to disfiguring scars and significantly impact patients’ quality of life. This interplay between PG and mental health issues like anxiety and depression underscores the need for holistic approaches to manage both the physical and psychological challenges faced by PG patients. Methods: This systematic review adhered to the PRISMA 2020 guidelines, focusing exclusively on full-text articles published in English between 2015 and 2024. Result: A total of over 600 publications were initially identified through the database search. Following a rigorous three-stage screening process, eight studies were selected for comprehensive analysis. These studies were critically examined to provide an in-depth evaluation of depression and anxiety among adults with pyoderma gangrenosum. Conclusion: Pyoderma gangrenosum, a chronic autoimmune disorder, significantly impacts patients' mental health due to painful ulcers, visible lesions, and social isolation. Untreated depression can exacerbate pain perceptions and reduce treatment satisfaction. Healthcare providers must screen for and address mental health conditions in PG patients, utilizing psychological support and counseling to address both physical and mental health issues.

Altered body as a source of interactional problems in the family of individuals with neurofibromatosis type 1 - A polish study.

Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder, whose clinical picture is dominated by visible body changes as well as numerous somatic and behavioural abnormalities. The aim of the study was to explore the ways in which the individual experiences NF1 in everyday life, with particular emphasis on the impact of the altered body on family interactions, in addition to the personal and social identity of individuals with NF1. A qualitative study was performed using individual in-depth interviews with 93 individuals with NF1 (median age: 36.69; range: 18 to 64; 26% males). Body changes caused by NF1 determine the specificity of social interactions in the families of the sick. The strength and direction of the impact of body changes on social interactions depends on their type (visibility, invisibility), as well as the meanings given to them. The visibility of disease lesions triggers an attitude of excessive control and stigmatization in the family, especially on the part of the mothers of individuals with NF1, and prompts a tendency to define the individual through the prism of the disease and its bodily manifestations. In turn, the lack of visibility of disease symptoms gives rise to, especially on the part of the fathers of the sick, opposing attitudes of disease denial, normalization of its symptoms and a tendency to question the disease identity of individuals with NF1. The great intensity of interactional problems concerns especially those families in which NF1 was transmitted through inheritance, and family members blame each other for the disease. This leads to repression and denial of the disease, excluding it from the scope of issues discussed in the family, which is an attempt to avoid the attribution of blame for the disease. The body changes resulting from NF1 have social consequences that are of critical importance in the lives of the sick. The impact of NF1 on family interactions depends on the ways in which the disease is understood by the sick individual and his or her family members. The obtained patient-driven data constitute a convenient starting point for designing personalized interventions supporting individuals with NF1 and their families.

Diagnosis of vascular lesions in the brain – comparing T_2 and FLAIR sequences

ABSTRACT Introduction: Vascular brain lesions refer to brain damage caused by problems with blood vessels and can include various disorders such as stroke, aneurysms, blood clots, and others. Because different brain tissues have different characteristic relaxation times, and the FLAIR sequence can also be used to deal with different tissue stresses. the sequence provides high intensity while the FLAIR sequence achieves complete saturation of cerebrospinal fluid. The objectives of this study are to compare the visualization of vascular lesions using and the FLAIR sequence and to determine which sequence provides a better depiction and additional information about vascular lesions. Research Methods: The study was designed as a retrospective descriptive study, conducted at the Private Healthcare Institution 'Medical Center' in Travnik using an MRI machine: MRI Siemens Avanto A + Tim + Dot System, with a strength of 1.5 T. The study involved 50 patients diagnosed with vascular lesions. Results: In the age group from 50 to 59 years, 7 patients with FAZEKAS 0 – 1 (46.66%), 4 patients with FAZEKAS 1 (26.66%), 3 patients with FAZEKAS 2 (20%) and one patient with FAZEKAS 3 (6.66%) were diagnosed. In the age group from 60 to 69 years, 6 patients with FAZEKAS 0 – 1 (28.57%), 6 patients with FAZEKAS 1 (28.57%), 6 patients with FAZEKAS 2 and 3 patients with FAZEKAS 3 (14.28%) were diagnosed. In the 70 to 79 age group, 2 patients were diagnosed with FAZEKAS 0 – 1 (14.28%), 5 patients were diagnosed with FAZEKAS 1 (35.71%), 5 patients were diagnosed with FAZEKAS 2 (35.71%) and 2 patients were diagnosed with FAZEKAS 3 (14.28%). Discussion: Several studies have been conducted to evaluate the sensitivity of and FLAIR sequences in the diagnosis of vascular lesions in the brain. In the mentioned studies, it was found that the FLAIR sequence possesses superior capabilities in identifying and better displaying vascular lesions compared to healthy brain tissue. After measuring lesions in all 50 patients enrolled in the study, they were divided by size into three different groups: Lesions smaller than 10 millimeters; Lesions larger than 10 millimeters and smaller than 20 millimeters; Lesions larger than 20 millimeters. After statistical processing of the examined sample within this study, it was found that the FLAIR sequence provides a better representation of vascular lesions in the brain compared to the sequence in all three different groups, and it is concluded that the differences are statistically significant in favor of the FLAIR sequence in all three observed lesion sizes. The prognostic value of FLAIR vascular hyperintensity still needs to be investigated. Future studies will determine in which settings the presence of FLAIR vascular hyperintensity can be used as valuable information for the clinician. FLAIR vascular hyperintensities indicate a risk of persistent vascular stenosis or occlusion, associated with an increased risk of future stroke. They also help identify patients with favorable collateral blood flow, who could benefit from aggressive revascularization therapy. Conclusion: Statistically, there was a difference in the better presentation of vascular lesions on the FLAIR sequence compared to the sequence. In some cases, a sequence may be sufficient but in most cases a FLAIR sequence is preferable. Although the noise level is higher on the FLAIR sequence compared to the standard sequence, the FLAIR sequence is more useful in detecting vascular lesions.

Automatic Watershed Segmentation of Cancerous Lesions in Unsupervised Breast Histology Images

Segmentation of nuclei in histology images is key in analyzing and quantifying morphology changes of nuclei features and tissue structures. Conventional diagnosis, segmenting, and detection methods have relied heavily on the manual-visual inspection of histology images. These methods are only effective on clearly visible cancerous lesions on histology images thus limited in their performance due to the complexity of tissue structures in histology images. Hence, early detection of breast cancer is key for treatment and profits from Computer-Aided-Diagnostic (CAD) systems introduced to efficiently and automatically segment and detect nuclei cells in pathology. This paper proposes, an automatic watershed segmentation method of cancerous lesions in unsupervised human breast histology images. Firstly, this approach pre-processes data through various augmentation methods to increase the size of dataset images, then a stain normalization technique is applied to these augmented images to isolate nuclei features from tissue structures. Secondly, data enhancement techniques namely; erosion, dilation, and distance transform are used to highlight foreground and background pixels while removing unwanted regions from the highlighted nuclei objects on the image. Consequently, the connected components method groups these highlighted pixel components with similar intensity values and, assigns them to their relevant labeled component binary mask. Once all binary masked groups have been determined, a deep-learning recurrent neural network from the Keras architecture uses this information to automatically segment nuclei objects with cancerous lesions and their edges on the image via watershed filling. This segmentation method is evaluated on an unsupervised, augmented human breast cancer histology dataset of 11,151 images. This proposed method produced a significant evaluation result of 98% F1-accuracy score.

QOL-06. OPTIMIZING NEUROFIBROMATOSIS CARE: A COMPREHENSIVE ECONOMIC EVALUATION OF A SPECIALIZED EXPERTISE CENTER’S IMPACT ON PATIENT OUTCOMES

Abstract Neurofibromatosis type 1 (NF1), NF2-related schwannomatosis (NF2) and other schwannomatoses represent a spectrum of genetic disorders characterized by the development of tumors on nerve tissues, profoundly impacting patients’ quality of life and posing complex challenges. Recognizing the imperative for comprehensive care delivery, we undertook to implement a Neurofibromatosis Expertise Center (CE) at the Centre hospitalier de l’Université de Montréal (CHUM), Quebec, Canada. Employing a robust analysis framework, we aimed to assess the economic viability of the CE by quantifying the Quality-Adjusted Life Years (QALYs) gained through centralized multidisciplinary neurofibromatosis care (cost-utility ratio = CAD/QALY gained). Leveraging data from validated questionnaires including the SF-6D, our preliminary analysis revealed significant enhancements in patients’ quality of life across diverse domains, including physical pain, visible cutaneous lesions, cognitive dysfunction, hearing loss, malignancies, psychiatric comorbidities, unemployment, physical disability, and social isolation. Notably, among the respondents (N = 115), patients receiving CE services reported a 12% increase in general health compared to a 25% decline among those without CE services. Moreover, 28% of CE patients reported improved overall health compared to 12% of those without CE services. Using the Work Productivity and Activity Impairment questionnaire (WPAI-GH), we found that cohorts followed in CE for ≥ 1 year (N = 45) experienced less work productivity losses compared to the most recent cohort (N = 32), which presented scores exceeding 6 on a 1-to-10 scale. We hypothesize that the establishment of the CE will yield profound improvements in patient health outcomes and alleviate financial strains on the Ministère de la Santé et des Services Sociaux du Québec (MSSS). Therefore, our next steps include discussing a strategy for funding application to the MSSS to ensure the accessibility of necessary care for patients. Continuing data collection and analysis will also provide a more comprehensive overview of patient characteristics and needs.

Endoluminal approaches for colorectal neoplasia in inflammatory bowel disease: a viable alternative for colectomy?

BackgroundEndoscopic resection of visible dysplastic lesions in patients with inflammatory bowel disease (IBD) is an alternative to colectomy. The endoscopic techniques that can be used include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and ESD combined with EMR. These endoscopic approaches may allow organ preservation in patients with IBD. This study aimed to evaluate the outcomes of endoscopic resection, including EMR, ESD, and ESD combined with EMR, for the treatment of colorectal dysplasia in patients with IBD. MethodsThis was a retrospective review of patients with IBD who underwent endoscopic resection for colorectal dysplasia at our tertiary care center between 2014 and 2023. Patients were identified via a search of our endoscopy database. Medical records were reviewed to collect data on patient demographics, IBD history, details of endoscopic technique, procedural factors, final pathology results, and outcomes, including recurrence of dysplasia. ResultsA total of 50 patients with IBD who underwent endoscopic resection were included in the study, with 38 ESD cases, 11 ESD combined with EMR cases, and 1 EMR case. The median age was 62 years, (IQR, 54–68), and 34 patients (68%) were male. The median body mass index was 27.6 kg/m2 (IQR, 24.8–31.7). The underlying diagnoses were ulcerative colitis in 33 patients (66%) and Crohn’s disease in 17 patients (33%). The median disease duration was 27.5 years (IQR, 8–30). Polyp locations were distributed as follows: right colon, rectum, left colon, transverse colon, and cecum, with 9 polyps (18%) in each area. The median procedure time was 47.5 min (IQR, 31.2–73.7). En bloc resection was performed in 34 patients (68%), and piecemeal resection was performed in 16 patients (32%). On pathology, the median lesion size was 23.5 mm (IQR, 20.2–40.0). High-grade dysplasia was found in 7 patients (14%), whereas low-grade dysplasia was found in 15 patients (30%). During a median follow-up period of 3 years, 18% of patients experienced recurrence. No significant difference in recurrence rates was observed between the ESD and ESD combined with EMR groups. ConclusionEndoscopic resection, including EMR, ESD, and ESD combined with EMR, is an effective treatment of visible dysplastic lesions and is a safe alternative to colectomy in patients with IBD. In this cohort, favorable short-term outcomes were observed after endoscopic resection.

68Ga-MY6349 PET/CT imaging to assess Trop2 expression in multiple types of cancer.

Background Considering trophoblast cell surface antigen 2 (Trop2) is overexpressed in a wide range of human epithelial cancers, it presents an attractive target for the diagnosis and treatment of multiple types of cancer. Herein, we have developed a Trop2-specific radiotracer, 68Ga-MY6349, and present a prospective, investigator-initiated trial to explore the clinical values of 68Ga-MY6349 PET/CT. Methods In this translational study, 90 patients with 15 types of cancer, who underwent 68Ga-MY6349 PET/CT, were enrolled prospectively. Among them, 78 patients underwent paired 68Ga-MY6349 and 18F-FDG PET/CT, and 12 patients with prostate cancer underwent paired 68Ga-MY6349 and 68Ga-PSMA-11 PET/CT. Results Among the 90 patients across 15 types of cancer, 68Ga-MY6349 uptake in tumors was generally high but heterogeneous, varying among lesions, patients, and cancer types. Trop2 expression level determined by immunohistochemistry was highly correlated with 68Ga-MY6349 uptake at primary and metastatic tumor sites. 68Ga-MY6349 PET/CT showed higher tumor uptake (quantified by SUVmax) than 18F-FDG PET/CT in certain types of cancer, including breast (7.2 vs. 5.4, P < 0.001), prostate (9.2 vs. 3.0, P < 0.001), and thyroid cancers (8.5 vs. 3.7, P < 0.001). When compared with 68Ga-PSMA-11, 68Ga-MY6349 PET/CT exhibited comparable lesion uptake (12.2 vs. 12.5, P = 0.223) but a better tumor-to-background contrast (15.8 vs. 12.2, P < 0.001) for primary and metastatic prostate cancer, allowing visualization of more metastatic lesions. Conclusion 68Ga-MY6349 PET/CT is a non-invasive method for comprehensively assessing Trop2 expression in tumors, which can improve the diagnosis and staging for cancer patients, and aid in the decision-making for Trop2-targeted therapies and advancing personalized treatment.