Esophageal dissection is a rare condition, characterized by disruption of the submucosa from the muscular layer of the esophageal wall. It is commonly iatrogenic in etiology and patients typically present with acute onset dysphagia, odynophagia, and retrosternal pain. The condition can be diagnosed endoscopically; however, contrast swallow studies either with CT or fluoroscopy carry less risk and are the imaging investigations of choice for this condition. Patients are managed conservatively in the majority of cases. In this case report, we present a case of chronic esophageal dissection in a 15-year-old male who had undergone endoscopic removal of a foreign body from the esophagus several years prior. We discuss the clinical features, radiological diagnosis, and management of this condition.
{"title":"Chronic esophageal dissection: Delayed diagnosis in a 15-year-old male","authors":"N. Vakharia, U. N. Sirisena, U. Mandalia","doi":"10.25259/JCIS_3_2022","DOIUrl":"https://doi.org/10.25259/JCIS_3_2022","url":null,"abstract":"Esophageal dissection is a rare condition, characterized by disruption of the submucosa from the muscular layer of the esophageal wall. It is commonly iatrogenic in etiology and patients typically present with acute onset dysphagia, odynophagia, and retrosternal pain. The condition can be diagnosed endoscopically; however, contrast swallow studies either with CT or fluoroscopy carry less risk and are the imaging investigations of choice for this condition. Patients are managed conservatively in the majority of cases. In this case report, we present a case of chronic esophageal dissection in a 15-year-old male who had undergone endoscopic removal of a foreign body from the esophagus several years prior. We discuss the clinical features, radiological diagnosis, and management of this condition.","PeriodicalId":15512,"journal":{"name":"Journal of Clinical Imaging Science","volume":"69 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76933042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives (1) To calculate the sensitivity and specificity of the Hounsfield Unit (HU), the HU to hematocrit (H:H) ratio, and the D-dimer level in the diagnosis of acute CVST. (2) To assess the D-dimer level’s linear relationship with the HU and the H:H ratio. Materials and Methods A single-center retrospective case-control study was conducted from 2005 to 2020. The inclusion criteria for the thrombosed and control groups were specified. A region of interest (ROI) was plotted on the respective sinuses to calculate the HU. The H:H ratio was calculated by dividing the HU value by the hematocrit value. The receiver operating characteristic curve was used to calculate the sensitivity and specificity of the HU and the H:H ratio at different cutoff values. The Pearson correlation was used to assess the linear relationship between the D-dimer level and the HU and H:H ratio. Results There were 19 patients in the thrombosed group and 28 patients in the control group. There were significant differences in the mean HU (71 ± 6.3 vs. 45 ± 4.8, P < 0.001) and the mean H:H ratio (2.11 ± 0.38 vs. 1.46 ± 0.63,P < 0.001). An optimal HU value of 56 yielded 100% sensitivity and specificity. An H:H value of 1.48 yielded a sensitivity of 100% and a specificity of 65%, an H:H ratio of 1.77 demonstrated a sensitivity of 85% and a specificity of 90%, and an H:H ratio of 1.88 yielded a sensitivity of 79% and a specificity of 93%. D-dimer levels had a 95% and 71% sensitivity and specificity, respectively. There was a significant moderately positive linear correlation between the D-dimer level and the HU (r = 0.52, P < 0.001) and the H:H ratio (r = 0.61, P < 0.001). Conclusion Unenhanced CT of the brain can be a valuable objective diagnostic tool for acute CVST diagnosis. Hounsfield blood density and its normalized ratio with hematocrit are positively correlated with D-dimer levels, which may indicate active blood coagulation in a cerebral venous sinus.
目的(1)计算Hounsfield Unit (HU)、HU / hematocrit (H:H)比值、d -二聚体水平对急性CVST诊断的敏感性和特异性。(2)评价d -二聚体水平与HU和H:H比的线性关系。材料与方法2005 - 2020年采用单中心回顾性病例对照研究。明确了血栓形成组和对照组的纳入标准。在各自的鼻窦上绘制感兴趣区域(ROI)以计算HU。H:H比值由HU值除以红细胞压积值计算。采用受试者工作特征曲线计算不同截止值下HU和H:H比的灵敏度和特异性。采用Pearson相关性评估d -二聚体水平与HU和H:H比值之间的线性关系。结果血栓形成组19例,对照组28例。平均HU(71±6.3比45±4.8,P < 0.001)和平均H:H比(2.11±0.38比1.46±0.63,P < 0.001)差异有统计学意义。最佳HU值为56,灵敏度和特异性均为100%。当H:H值为1.48时,敏感性为100%,特异性为65%;当H:H值为1.77时,敏感性为85%,特异性为90%;当H:H值为1.88时,敏感性为79%,特异性为93%。d -二聚体水平的敏感性和特异性分别为95%和71%。d -二聚体水平与HU (r = 0.52, P < 0.001)和H:H比(r = 0.61, P < 0.001)呈显著的中正线性相关。结论CT对急性CVST的诊断是一种有价值的客观诊断工具。Hounsfield血密度及其与红细胞压积的归一化比值与d -二聚体水平呈正相关,可能提示脑静脉窦血凝活动。
{"title":"The diagnostic utility of unenhanced computed tomography of the brain and D-dimer levels in acute cerebral venous sinus thrombosis: A quantitative study","authors":"Omar A. Alharbi, K. Alahmadi","doi":"10.25259/JCIS_76_2021","DOIUrl":"https://doi.org/10.25259/JCIS_76_2021","url":null,"abstract":"Objectives (1) To calculate the sensitivity and specificity of the Hounsfield Unit (HU), the HU to hematocrit (H:H) ratio, and the D-dimer level in the diagnosis of acute CVST. (2) To assess the D-dimer level’s linear relationship with the HU and the H:H ratio. Materials and Methods A single-center retrospective case-control study was conducted from 2005 to 2020. The inclusion criteria for the thrombosed and control groups were specified. A region of interest (ROI) was plotted on the respective sinuses to calculate the HU. The H:H ratio was calculated by dividing the HU value by the hematocrit value. The receiver operating characteristic curve was used to calculate the sensitivity and specificity of the HU and the H:H ratio at different cutoff values. The Pearson correlation was used to assess the linear relationship between the D-dimer level and the HU and H:H ratio. Results There were 19 patients in the thrombosed group and 28 patients in the control group. There were significant differences in the mean HU (71 ± 6.3 vs. 45 ± 4.8, P < 0.001) and the mean H:H ratio (2.11 ± 0.38 vs. 1.46 ± 0.63,P < 0.001). An optimal HU value of 56 yielded 100% sensitivity and specificity. An H:H value of 1.48 yielded a sensitivity of 100% and a specificity of 65%, an H:H ratio of 1.77 demonstrated a sensitivity of 85% and a specificity of 90%, and an H:H ratio of 1.88 yielded a sensitivity of 79% and a specificity of 93%. D-dimer levels had a 95% and 71% sensitivity and specificity, respectively. There was a significant moderately positive linear correlation between the D-dimer level and the HU (r = 0.52, P < 0.001) and the H:H ratio (r = 0.61, P < 0.001). Conclusion Unenhanced CT of the brain can be a valuable objective diagnostic tool for acute CVST diagnosis. Hounsfield blood density and its normalized ratio with hematocrit are positively correlated with D-dimer levels, which may indicate active blood coagulation in a cerebral venous sinus.","PeriodicalId":15512,"journal":{"name":"Journal of Clinical Imaging Science","volume":" 11","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72383212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salivary lymphadenoma is an extremely rare neoplasm that is usually seen in the older patient population, arising sporadically on one side and almost exclusive to the parotid gland. Imaging and pathology findings can mimic both benign and malignant tumors, and therefore, this lesion may be misdiagnosed if not on the differential diagnosis. This article reviews the clinical presentation, as well as the pathology and imaging findings of salivary lymphadenoma in the setting of Sjogren’s syndrome.
{"title":"Parotid sebaceous lymphadenoma associated with Sjogren’s syndrome: Review of pathologic and radiologic characteristics and clinical presentation","authors":"J. Janus, Obaie Mzaik, A. Bhatt","doi":"10.25259/JCIS_14_2022","DOIUrl":"https://doi.org/10.25259/JCIS_14_2022","url":null,"abstract":"Salivary lymphadenoma is an extremely rare neoplasm that is usually seen in the older patient population, arising sporadically on one side and almost exclusive to the parotid gland. Imaging and pathology findings can mimic both benign and malignant tumors, and therefore, this lesion may be misdiagnosed if not on the differential diagnosis. This article reviews the clinical presentation, as well as the pathology and imaging findings of salivary lymphadenoma in the setting of Sjogren’s syndrome.","PeriodicalId":15512,"journal":{"name":"Journal of Clinical Imaging Science","volume":"44 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80709146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sir William Osler coined the term “mycotic” to identify aneurysms secondary to an infectious cause, which may not be necessarily fungal and are caused mainly by bacteria. The literature’s reported incidence of coronary artery aneurysms (CAA) is from 1.5-5%. The right coronary artery (RCA) is mainly involved, followed by the left side coronary circulation. Mycotic aneurysms are more commonly associated with infective endocarditis. More recently, coronary artery stents, particularly drug-eluting stents, are typically causing mycotic coronary aneurysms. CT angiography (CTA) has been the forefront diagnostic modality, showing both the lumen and wall of the coronary arteries. It also aids in preoperative planning. MRI is useful in diagnosing and following children with Kawasaki’s disease. Smaller mycotic coronary aneurysms may resolve with antibiotic therapy; however, aneurysms more significant than 1-2 cm diameter needs corrective surgery. Early diagnosis and appropriate management are the critical factors in the successful treatment of infective coronary artery aneurysms.
{"title":"Mycotic and non-mycotic coronary artery aneurysms—A review of the rarity","authors":"Vishal Kukkar, H. Kapoor, A. Aggarwal","doi":"10.25259/JCIS_218_2021","DOIUrl":"https://doi.org/10.25259/JCIS_218_2021","url":null,"abstract":"Sir William Osler coined the term “mycotic” to identify aneurysms secondary to an infectious cause, which may not be necessarily fungal and are caused mainly by bacteria. The literature’s reported incidence of coronary artery aneurysms (CAA) is from 1.5-5%. The right coronary artery (RCA) is mainly involved, followed by the left side coronary circulation. Mycotic aneurysms are more commonly associated with infective endocarditis. More recently, coronary artery stents, particularly drug-eluting stents, are typically causing mycotic coronary aneurysms. CT angiography (CTA) has been the forefront diagnostic modality, showing both the lumen and wall of the coronary arteries. It also aids in preoperative planning. MRI is useful in diagnosing and following children with Kawasaki’s disease. Smaller mycotic coronary aneurysms may resolve with antibiotic therapy; however, aneurysms more significant than 1-2 cm diameter needs corrective surgery. Early diagnosis and appropriate management are the critical factors in the successful treatment of infective coronary artery aneurysms.","PeriodicalId":15512,"journal":{"name":"Journal of Clinical Imaging Science","volume":"96 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75916658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Kunimatsu, A. Kunimatsu, Y. Uchida, I. Mori, Shigeru Kiryu
Objectives To investigate the application of apparent diffusion coefficient (ADC) histogram analysis in differentiating between benign and malignant breast lesions detected as non-mass enhancement on MRI. Materials and Methods A retrospective study was conducted for 25 malignant and 26 benign breast lesions showing non-mass enhancement on breast MRI. An experienced radiologist without prior knowledge of the pathological results drew a region of interest (ROI) outlining the periphery of each lesion on the ADC map. A histogram was then made for each lesion. Following a univariate analysis of 18 summary statistics values, we conducted statistical discrimination after hierarchical clustering using Ward’s method. A comparison between the malignant and the benign groups was made using multiple logistic regression analysis and the Mann-Whitney U test. A P -value of less than 0.05 was considered statistically significant. Results Univariate analysis for the 18 summary statistics values showed the malignant group had greater entropy (P < 0.001) and lower uniformity (P < 0.001). While there was no significant difference in mean and skewness values, the malignant group tended to show a lower mean (P = 0.090) and a higher skewness (P = 0.065). Hierarchical clustering of the 18 summary statistics values identified four values (10th percentile, entropy, skewness, and uniformity) of which the 10th percentile values were significantly lower for the malignant group (P = 0.035). Conclusions Whole-lesion ADC histogram analysis may be useful for differentiating malignant from benign lesions which show non-mass enhancement on breast MRI.
{"title":"Whole-lesion histogram analysis of apparent diffusion coefficient for the assessment of non-mass enhancement lesions on breast MRI","authors":"N. Kunimatsu, A. Kunimatsu, Y. Uchida, I. Mori, Shigeru Kiryu","doi":"10.25259/JCIS_201_2021","DOIUrl":"https://doi.org/10.25259/JCIS_201_2021","url":null,"abstract":"Objectives To investigate the application of apparent diffusion coefficient (ADC) histogram analysis in differentiating between benign and malignant breast lesions detected as non-mass enhancement on MRI. Materials and Methods A retrospective study was conducted for 25 malignant and 26 benign breast lesions showing non-mass enhancement on breast MRI. An experienced radiologist without prior knowledge of the pathological results drew a region of interest (ROI) outlining the periphery of each lesion on the ADC map. A histogram was then made for each lesion. Following a univariate analysis of 18 summary statistics values, we conducted statistical discrimination after hierarchical clustering using Ward’s method. A comparison between the malignant and the benign groups was made using multiple logistic regression analysis and the Mann-Whitney U test. A P -value of less than 0.05 was considered statistically significant. Results Univariate analysis for the 18 summary statistics values showed the malignant group had greater entropy (P < 0.001) and lower uniformity (P < 0.001). While there was no significant difference in mean and skewness values, the malignant group tended to show a lower mean (P = 0.090) and a higher skewness (P = 0.065). Hierarchical clustering of the 18 summary statistics values identified four values (10th percentile, entropy, skewness, and uniformity) of which the 10th percentile values were significantly lower for the malignant group (P = 0.035). Conclusions Whole-lesion ADC histogram analysis may be useful for differentiating malignant from benign lesions which show non-mass enhancement on breast MRI.","PeriodicalId":15512,"journal":{"name":"Journal of Clinical Imaging Science","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80163520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yi Lam Priscilla Chan, Chun Hung Kevin Yu, W. Chong, K. Y. Kwok, Allen Li
Diffuse cystic lung disease represents a diverse group of uncommon disorders that has been increasingly diagnosed due to the increasing use of computed tomography. It poses a frequent diagnostic challenge to radiologists due to the similar clinical and radiological features these diseases share. This pictorial review includes selected cases from the Hospital Authority New Territories West Cluster (NTWC) in Hong Kong from the past 3 years. It will illustrate the spectrum of diffuse cystic lung diseases, including some rarer entities in our locality, and identify the pertinent differentiating imaging features on CT. A flowchart to summarize these features is provided at the end to aid in diagnosis.
{"title":"Pictorial review of computed tomography features of diffuse cystic lung disease","authors":"Yi Lam Priscilla Chan, Chun Hung Kevin Yu, W. Chong, K. Y. Kwok, Allen Li","doi":"10.25259/JCIS_210_2021","DOIUrl":"https://doi.org/10.25259/JCIS_210_2021","url":null,"abstract":"Diffuse cystic lung disease represents a diverse group of uncommon disorders that has been increasingly diagnosed due to the increasing use of computed tomography. It poses a frequent diagnostic challenge to radiologists due to the similar clinical and radiological features these diseases share. This pictorial review includes selected cases from the Hospital Authority New Territories West Cluster (NTWC) in Hong Kong from the past 3 years. It will illustrate the spectrum of diffuse cystic lung diseases, including some rarer entities in our locality, and identify the pertinent differentiating imaging features on CT. A flowchart to summarize these features is provided at the end to aid in diagnosis.","PeriodicalId":15512,"journal":{"name":"Journal of Clinical Imaging Science","volume":"62 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86129814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report two cases of peripartum ruptured ovarian artery aneurysms (OAA). One patient was treated through endovascular embolization and the other with percutaneous thrombin injection. Multiple additional unruptured OAAs were incidentally discovered in each patient. We describe the pathophysiologic basis for OAA rupture, approaches to treatment, and suggest management strategies for incidentally discovered ovarian aneurysms.
{"title":"Peripartum hemorrhage: Two cases of ruptured ovarian artery aneurysms with additional multifocal intact aneurysms","authors":"T. Arleo, G. Peters, N. Kokabi, B. Majdalany","doi":"10.25259/JCIS_145_2021","DOIUrl":"https://doi.org/10.25259/JCIS_145_2021","url":null,"abstract":"We report two cases of peripartum ruptured ovarian artery aneurysms (OAA). One patient was treated through endovascular embolization and the other with percutaneous thrombin injection. Multiple additional unruptured OAAs were incidentally discovered in each patient. We describe the pathophysiologic basis for OAA rupture, approaches to treatment, and suggest management strategies for incidentally discovered ovarian aneurysms.","PeriodicalId":15512,"journal":{"name":"Journal of Clinical Imaging Science","volume":"62 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84662344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
HIV is a multisystem disease process that can affect the cardiovascular system resulting in vasculopathy. As highly active anti-retroviral therapy has allowed patients to live longer with the disease, vascular complications such as aneurysms, occlusive disease, spontaneous arteriovenous fistulae, and arterial dissections have been described. The pathogenesis of vascular-related complications in HIV is poorly understood but is thought to involve an interplay between viral-induced inflammation, vascular smooth muscle changes, endothelial alterations, and circulating blood factors. The most well-described management strategies for symptomatic aneurysm-related complications are surgical in nature, with mostly anecdotal reports of endovascular intervention. We present a case of a 24-year-old male who was found to have findings consistent with HIV vasculopathy on angiography after presenting with acute GI hemorrhage secondary to left gastric artery bleeding. Our patient was managed with endovascular embolization. Although studies have shown promise regarding the endovascular management of HIV-related aneurysmal complications in the short term, more research is needed to evaluate the long-term success of these interventions.
{"title":"Endovascular management of HIV vasculopathy","authors":"Jack B. Newcomer, Emad A. Chishti, D. Raissi","doi":"10.25259/JCIS_226_2021","DOIUrl":"https://doi.org/10.25259/JCIS_226_2021","url":null,"abstract":"HIV is a multisystem disease process that can affect the cardiovascular system resulting in vasculopathy. As highly active anti-retroviral therapy has allowed patients to live longer with the disease, vascular complications such as aneurysms, occlusive disease, spontaneous arteriovenous fistulae, and arterial dissections have been described. The pathogenesis of vascular-related complications in HIV is poorly understood but is thought to involve an interplay between viral-induced inflammation, vascular smooth muscle changes, endothelial alterations, and circulating blood factors. The most well-described management strategies for symptomatic aneurysm-related complications are surgical in nature, with mostly anecdotal reports of endovascular intervention. We present a case of a 24-year-old male who was found to have findings consistent with HIV vasculopathy on angiography after presenting with acute GI hemorrhage secondary to left gastric artery bleeding. Our patient was managed with endovascular embolization. Although studies have shown promise regarding the endovascular management of HIV-related aneurysmal complications in the short term, more research is needed to evaluate the long-term success of these interventions.","PeriodicalId":15512,"journal":{"name":"Journal of Clinical Imaging Science","volume":"68 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79965425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alban Wei Shern Leong, J. Langdon, Vivek Malhotra, U. Mandalia
Melorheostosis is a rare bone dysplasia of unknown etiology with an incidence of 0.9 cases per million. It typically affects the upper or lower limbs and can cause severe deformity and functional impairment. Diagnosis is radiological and is often described as a “flowing candle wax” appearance on the radiograph. Treatment is individualized depending on the site and severity of symptoms. We report a rare case of spinal melorheostosis. We demonstrate the imaging features of melorheostosis on CT and MRI. We discuss the classification, genetics, and management of this condition.
{"title":"A case of spinal melorheostosis","authors":"Alban Wei Shern Leong, J. Langdon, Vivek Malhotra, U. Mandalia","doi":"10.25259/JCIS_202_2021","DOIUrl":"https://doi.org/10.25259/JCIS_202_2021","url":null,"abstract":"Melorheostosis is a rare bone dysplasia of unknown etiology with an incidence of 0.9 cases per million. It typically affects the upper or lower limbs and can cause severe deformity and functional impairment. Diagnosis is radiological and is often described as a “flowing candle wax” appearance on the radiograph. Treatment is individualized depending on the site and severity of symptoms. We report a rare case of spinal melorheostosis. We demonstrate the imaging features of melorheostosis on CT and MRI. We discuss the classification, genetics, and management of this condition.","PeriodicalId":15512,"journal":{"name":"Journal of Clinical Imaging Science","volume":"22 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80901381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elif Soya, Nur Ekenel, R. Savaş, T. Toprak, J. Bewes, Ozkan Doganay
Objectives: Computed tomography (CT) plays a complementary role in the diagnosis of the pneumonia-burden of COVID-19 disease. However, the low contrast of areas of inflammation on CT images, areas of infection are difficult to identify. The purpose of this study is to develop a post-image-processing method for quantitative analysis of COVID-19 pneumonia-related changes in CT attenuation values using a pixel-based analysis rather than more commonly used clustered focal pneumonia volumes. The COVID-19 pneumonia burden is determined by experienced radiologists in the clinic. Previous AI software was developed for the measurement of COVID-19 lesions based on the extraction of local pneumonia features. In this respect, changes in the pixel levels beyond the clusters may be overlooked by deep learning algorithms. The proposed technique focuses on the quantitative measurement of COVID-19 related pneumonia over the entire lung in pixel-by-pixel fashion rather than only clustered focal pneumonia volumes. Material and Methods: Fifty COVID-19 and 50 age-matched negative control patients were analyzed using the proposed technique and commercially available artificial intelligence (AI) software. The %pneumonia was calculated using the relative volume of parenchymal pixels within an empirically defined CT density range, excluding pulmonary airways, vessels, and fissures. One-way ANOVA analysis was used to investigate the statistical difference between lobar and whole lung %pneumonia in the negative control and COVID-19 cohorts. Results: The threshold of high-and-low CT attenuation values related to pneumonia caused by COVID-19 were found to be between ₋642.4 HU and 143 HU. The %pneumonia of the whole lung, left upper, and lower lobes were 8.1 ± 4.4%, 6.1 ± 4.5, and 11.3 ± 7.3% for the COVID-19 cohort, respectively, and statistically different (P < 0.01). Additionally, the pixel-based methods correlate well with existing AI methods and are approximately four times more sensitive to pneumonia particularly at the upper lobes compared with commercial software in COVID-19 patients (P < 0.01). Conclusion: Pixel-by-pixel analysis can accurately assess pneumonia in COVID-19 patients with CT. Pixel-based techniques produce more sensitive results than AI techniques. Using the proposed novel technique, %pneumonia could be quantitatively calculated not only in the clusters but also in the whole lung with an improved sensitivity by a factor of four compared to AI-based analysis. More significantly, pixel-by-pixel analysis was more sensitive to the upper lobe pneumonia, while AI-based analysis overlooked the upper lung pneumonia region. In the future, this technique can be used to investigate the efficiency of vaccines and drugs and post COVID-19 effects.
目的:计算机断层扫描(CT)在COVID-19肺炎负担诊断中发挥补充作用。然而,CT图像上炎症区域对比度低,感染区域难以识别。本研究的目的是开发一种图像后处理方法,使用基于像素的分析来定量分析COVID-19肺炎相关CT衰减值的变化,而不是更常用的聚集性局灶性肺炎体积。COVID-19肺炎负担由临床经验丰富的放射科医生确定。以前的AI软件是基于局部肺炎特征的提取来测量COVID-19病变。在这方面,深度学习算法可能会忽略集群之外像素水平的变化。所提出的技术侧重于以逐像素的方式定量测量整个肺部的COVID-19相关肺炎,而不仅仅是聚集性局灶性肺炎体积。材料与方法:采用提出的技术和市售人工智能(AI)软件对50例COVID-19患者和50例年龄匹配的阴性对照患者进行分析。肺炎的百分比是根据经验定义的CT密度范围内的实质像素的相对体积计算的,不包括肺气道、血管和裂隙。采用单因素方差分析(One-way ANOVA)分析阴性对照组和COVID-19队列大叶性肺炎和全肺性肺炎的统计学差异。结果:与COVID-19肺炎相关的CT高低衰减值阈值在24.642.4 HU ~ 14.3hu之间。肺炎组全肺、左上肺叶、左下肺叶肺炎%分别为8.1±4.4%、6.1±4.5%、11.3±7.3%,差异有统计学意义(P < 0.01)。此外,基于像素的方法与现有的人工智能方法具有良好的相关性,并且与商业软件相比,对COVID-19患者的肺炎(特别是上肺叶)的敏感性约为四倍(P < 0.01)。结论:逐像素分析可准确评估COVID-19患者的肺炎。基于像素的技术比人工智能技术产生更敏感的结果。使用提出的新技术,不仅可以在群集中定量计算肺炎,而且可以在整个肺中定量计算,与基于人工智能的分析相比,灵敏度提高了四倍。更重要的是,逐像素分析对上肺肺炎更敏感,而基于人工智能的分析忽略了上肺肺炎区域。未来,该技术可用于研究疫苗和药物的效率以及COVID-19后的效果。
{"title":"Pixel-based analysis of pulmonary changes on CT lung images due to COVID-19 pneumonia","authors":"Elif Soya, Nur Ekenel, R. Savaş, T. Toprak, J. Bewes, Ozkan Doganay","doi":"10.25259/JCIS_172_2021","DOIUrl":"https://doi.org/10.25259/JCIS_172_2021","url":null,"abstract":"Objectives: Computed tomography (CT) plays a complementary role in the diagnosis of the pneumonia-burden of COVID-19 disease. However, the low contrast of areas of inflammation on CT images, areas of infection are difficult to identify. The purpose of this study is to develop a post-image-processing method for quantitative analysis of COVID-19 pneumonia-related changes in CT attenuation values using a pixel-based analysis rather than more commonly used clustered focal pneumonia volumes. The COVID-19 pneumonia burden is determined by experienced radiologists in the clinic. Previous AI software was developed for the measurement of COVID-19 lesions based on the extraction of local pneumonia features. In this respect, changes in the pixel levels beyond the clusters may be overlooked by deep learning algorithms. The proposed technique focuses on the quantitative measurement of COVID-19 related pneumonia over the entire lung in pixel-by-pixel fashion rather than only clustered focal pneumonia volumes. Material and Methods: Fifty COVID-19 and 50 age-matched negative control patients were analyzed using the proposed technique and commercially available artificial intelligence (AI) software. The %pneumonia was calculated using the relative volume of parenchymal pixels within an empirically defined CT density range, excluding pulmonary airways, vessels, and fissures. One-way ANOVA analysis was used to investigate the statistical difference between lobar and whole lung %pneumonia in the negative control and COVID-19 cohorts. Results: The threshold of high-and-low CT attenuation values related to pneumonia caused by COVID-19 were found to be between ₋642.4 HU and 143 HU. The %pneumonia of the whole lung, left upper, and lower lobes were 8.1 ± 4.4%, 6.1 ± 4.5, and 11.3 ± 7.3% for the COVID-19 cohort, respectively, and statistically different (P < 0.01). Additionally, the pixel-based methods correlate well with existing AI methods and are approximately four times more sensitive to pneumonia particularly at the upper lobes compared with commercial software in COVID-19 patients (P < 0.01). Conclusion: Pixel-by-pixel analysis can accurately assess pneumonia in COVID-19 patients with CT. Pixel-based techniques produce more sensitive results than AI techniques. Using the proposed novel technique, %pneumonia could be quantitatively calculated not only in the clusters but also in the whole lung with an improved sensitivity by a factor of four compared to AI-based analysis. More significantly, pixel-by-pixel analysis was more sensitive to the upper lobe pneumonia, while AI-based analysis overlooked the upper lung pneumonia region. In the future, this technique can be used to investigate the efficiency of vaccines and drugs and post COVID-19 effects.","PeriodicalId":15512,"journal":{"name":"Journal of Clinical Imaging Science","volume":"16 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91304196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}